Provider Demographics
NPI:1225194699
Name:VENEMA-WEISS, CORRY I (CNM)
Entity type:Individual
Prefix:MS
First Name:CORRY
Middle Name:I
Last Name:VENEMA-WEISS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 EASTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3066
Mailing Address - Country:US
Mailing Address - Phone:425-385-2819
Mailing Address - Fax:
Practice Address - Street 1:4400 37TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1609
Practice Address - Country:US
Practice Address - Phone:206-296-4650
Practice Address - Fax:206-296-0580
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003818367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9617937Medicaid
WAS72082Medicare UPIN
WA8866619Medicare PIN