Provider Demographics
NPI:1326596826
Name:WEINHEIMER, MARY JOAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOAN
Last Name:WEINHEIMER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:301 WINKWORTH PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1549
Mailing Address - Country:US
Mailing Address - Phone:315-413-3606
Mailing Address - Fax:315-469-2806
Practice Address - Street 1:700 E BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2201
Practice Address - Country:US
Practice Address - Phone:315-413-3606
Practice Address - Fax:315-469-2806
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF301210-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health