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General NPI Number Information
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NPI Number | 1841367315
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Entity Type | Individual
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Provider Name | JOAN ELLEN WEISENBECK PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 601 W HARRISON ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-4621
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Country | US
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Telephone | 336-349-3332
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Fax | 336-361-0022
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Provider Business Mailing Address
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Address Line | 320 STOKES RD
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City | REIDSVILLE
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State | NC
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Zip | 27320-8370
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Country | US
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Telephone | 336-349-7114
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Fax | 336-361-0022
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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 |
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License Number State | NC
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