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General NPI Number Information
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NPI Number | 1689182529
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Entity Type | Individual
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Provider Name | WESLEY D WEIDLE PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 8301 161ST AVE NE STE 202
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City | REDMOND
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State | WA
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Zip | 98052-3858
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Country | US
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Telephone | 425-979-4339
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Fax |
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Provider Business Mailing Address
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Address Line | 2912 SPRINGBORO W
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City | MORAINE
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State | OH
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Zip | 45439-1674
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Country | US
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Telephone | 937-855-6006
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.005416RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61039111
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License Number State | WA
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