Provider Demographics
NPI:1285490250
Name:WEIRAUCH, SKYLAR JAMES (PMHNP)
Entity type:Individual
Prefix:MR
First Name:SKYLAR
Middle Name:JAMES
Last Name:WEIRAUCH
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 REDWINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9135
Mailing Address - Country:US
Mailing Address - Phone:989-890-4729
Mailing Address - Fax:
Practice Address - Street 1:1827 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:MI
Practice Address - Zip Code:48756-8626
Practice Address - Country:US
Practice Address - Phone:989-873-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704366042363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health