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General NPI Number Information
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NPI Number | 1528332301
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Entity Type | Individual
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Provider Name | COLE JEFFREY WEISKE PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 3111 124TH AVE NW STE 200
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City | COON RAPIDS
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State | MN
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Zip | 55433-4573
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Country | US
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Telephone | 763-427-7300
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Fax | 763-427-2802
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Provider Business Mailing Address
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Address Line | 3111 124TH AVE NW STE 200
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City | COON RAPIDS
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State | MN
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Zip | 55433-4573
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Country | US
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Telephone | 763-427-7300
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Fax | 763-427-2802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11109
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License Number State | MN
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