MEDICARE: MRS. DOROTHY WEIS

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	367500000X	Certified Registered Nurse Anesthetist	1-058849	AL

General Provider Information

NPI Number	:	1912338229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY WEIS

Provider Business Mailing Address
First Line	:	10945 JIM BUSBY RD S
Second Line	:
City	:	THEODORE
State	:	AL
Zip	:	36582-7611
Country	:	US
Telephone Number	:	251-232-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	4621 MORRISON DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-3353
Country	:	US
Telephone Number	:	251-344-7474
Fax Number	:

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

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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