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NPI Code Detail

MEDICARE: MS. MARY LYON WEISFELD CRNA

MEDICARE: MS. MARY LYON WEISFELD CRNA
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
1367500000XCertified Registered Nurse Anesthetist38592TN
2367500000XCertified Registered Nurse Anesthetist027870VA
3367500000XCertified Registered Nurse Anesthetist0001056478VA
4367500000XCertified Registered Nurse AnesthetistARNP9389844FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14061629OTHERBLUE CROSS OF TENNESSEE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790763357
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY LYON WEISFELD CRNA
Provider Business Mailing Address
First Line : 5354 TIMBERLANE RD
Second Line :
City : LAKE WALES
State : FL
Zip : 33898-8959
Country : US
Telephone Number : 276-628-5017
Fax Number :
Provider Business Practice Location Address
First Line : 5354 TIMBERLANE RD
Second Line :
City : LAKE WALES
State : FL
Zip : 33898-8959
Country : US
Telephone Number : 276-973-5683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 11/02/2021

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