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General NPI Number Information
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NPI Number | 1952933210
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Entity Type | Individual
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Provider Name | JEFFREY C WEYENBERG
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Gender | Male
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | E9321 CRAIN RD
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City | NEW LONDON
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State | WI
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Zip | 54961-8520
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Country | US
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Telephone | 920-716-4694
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Fax | 920-716-9020
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Provider Business Mailing Address
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Address Line | E9321 CRAIN RD
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City | NEW LONDON
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State | WI
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Zip | 54961-8520
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Country | US
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Telephone | 920-716-4694
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Fax | 920-716-9020
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | WI
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