Provider Demographics
NPI:1316935547
Name:WEASE, JOHNNIE LOIS (NP)
Entity type:Individual
Prefix:MRS
First Name:JOHNNIE
Middle Name:LOIS
Last Name:WEASE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 ROYAL LINKS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6937
Mailing Address - Country:US
Mailing Address - Phone:843-971-9566
Mailing Address - Fax:843-971-9566
Practice Address - Street 1:1189 IRON BRIDGE DR
Practice Address - Street 2:#100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7401
Practice Address - Country:US
Practice Address - Phone:843-856-1210
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9942363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health