Provider Demographics
NPI:1386920577
Name:WEIRENS, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WEIRENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S FERRY ST
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2143
Mailing Address - Country:US
Mailing Address - Phone:763-576-0388
Mailing Address - Fax:763-576-0732
Practice Address - Street 1:1911 S FERRY ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2143
Practice Address - Country:US
Practice Address - Phone:763-576-0388
Practice Address - Fax:763-576-0732
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist