1437158219 NPI number — MRS. WINONA DARLENE WEIDEMANN R.N. F.N.P.

Table of content: MRS. WINONA DARLENE WEIDEMANN R.N. F.N.P. (NPI 1437158219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437158219 NPI number — MRS. WINONA DARLENE WEIDEMANN R.N. F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEIDEMANN
Provider First Name:
WINONA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N. F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIDEMANN
Provider Other First Name:
NONI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437158219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18550 DE PAUL DR
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
MORGAN HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95037-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-776-8040
Provider Business Mailing Address Fax Number:
708-776-9089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18550 DE PAUL DR
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
MORGAN HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95037-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-776-8040
Provider Business Practice Location Address Fax Number:
708-776-9089
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  CA216122 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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