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NPI Code Detail

MEDICARE: AMANDA NICOLE WEISE

MEDICARE: AMANDA NICOLE WEISE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramOH

General Provider Information

NPI Number : 1053258319
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NICOLE WEISE
Provider Business Mailing Address
First Line : 34 CORTLAND CIR
Second Line :
City : GENEVA
State : OH
Zip : 44041-9135
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6751 N CHESTNUT ST
Second Line :
City : RAVENNA
State : OH
Zip : 44266-3903
Country : US
Telephone Number : 330-296-3641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ AMANDA NICOLE WEISE ” Practice Location

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