MEDICARE: ABIGAIL WEINGARTEN LPN

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	164W00000X	Licensed Practical Nurse	L 78847-4	MN

General Provider Information

NPI Number	:	1386028934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL WEINGARTEN LPN

Provider Business Mailing Address
First Line	:	1322 ALTON ST APT 115
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3116
Country	:	US
Telephone Number	:	651-274-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 ALTON ST APT 115
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3116
Country	:	US
Telephone Number	:	651-274-6630
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	07/14/2015

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