MEDICARE: DR. BRANDEN LLOYD WEISGARBER PHD, CRNP

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	363L00000X	Nurse Practitioner	NP04723	OH

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	:	1356344329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDEN LLOYD WEISGARBER PHD, CRNP

Provider Business Mailing Address
First Line	:	1213 RUSSELL DR NW
Second Line	:
City	:	BOLIVAR
State	:	OH
Zip	:	44612-8418
Country	:	US
Telephone Number	:	330-878-5627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 WOOSTER RD
Second Line	:	STE 140
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-1569
Country	:	US
Telephone Number	:	330-674-9675
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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