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NPI Code Detail

MEDICARE: MRS. BETH A WEIDMAN APNP

MEDICARE: MRS. BETH A WEIDMAN APNP
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
1363LF0000XFamily Nurse Practitioner209008975IL
2363L00000XNurse Practitioner4246WI

Other Identifiers

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

General Provider Information

NPI Number : 1316248073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETH A WEIDMAN APNP
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 262-514-3700
Fax Number :
Provider Business Practice Location Address
First Line : 818 FOREST LN
Second Line :
City : WATERFORD
State : WI
Zip : 53185-4585
Country : US
Telephone Number : 262-514-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2010
Last Update Date : 10/18/2023

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