1659668549 NPI number — JODEE LYNNE WEGHORST RPH

Table of content: JODEE LYNNE WEGHORST RPH (NPI 1659668549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659668549 NPI number — JODEE LYNNE WEGHORST RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEGHORST
Provider First Name:
JODEE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1659668549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CABELA DR
Provider Second Line Business Mailing Address:
T-2231
Provider Business Mailing Address City Name:
TRIADELPHIA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26059-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-547-2981
Provider Business Mailing Address Fax Number:
304-547-2981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CABELA DR
Provider Second Line Business Practice Location Address:
T-2231
Provider Business Practice Location Address City Name:
TRIADELPHIA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26059-1023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-547-2981
Provider Business Practice Location Address Fax Number:
304-547-2981
Provider Enumeration Date:
06/30/2011

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: 183500000X , with the licence number:  RP0004506 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com