Provider Demographics
NPI:1225826902
Name:WEIS, ZACHARY JAMES
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:WEIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16590 CINNAMON DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1440
Mailing Address - Country:US
Mailing Address - Phone:402-889-5857
Mailing Address - Fax:
Practice Address - Street 1:1623 S 208TH ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2717
Practice Address - Country:US
Practice Address - Phone:641-210-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE85343765385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care