MEDICARE: JANE E WEISS PA

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
1	363AM0700X	Medical Physician Assistant	783	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245235662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE E WEISS PA

Provider Business Mailing Address
First Line	:	325 BUTTS AVE
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-1412
Country	:	US
Telephone Number	:	608-372-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 BUTTS AVE
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-1412
Country	:	US
Telephone Number	:	608-372-5951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	05/22/2013

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Directions to “ JANE E WEISS PA” Practice Location

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