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NPI Code Detail

MEDICARE: AMY COLLEEN WEIDEMAN

MEDICARE: AMY COLLEEN WEIDEMAN
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1881540581
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY COLLEEN WEIDEMAN
Provider Business Mailing Address
First Line : 702 SUNSET DR
Second Line :
City : ONTARIO
State : OR
Zip : 97914-3121
Country : US
Telephone Number : 541-889-9167
Fax Number : 541-889-7873
Provider Business Practice Location Address
First Line : 702 SUNSET DR
Second Line :
City : ONTARIO
State : OR
Zip : 97914-3121
Country : US
Telephone Number : 541-889-9167
Fax Number : 541-889-7873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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Directions to “ AMY COLLEEN WEIDEMAN ” Practice Location

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