Provider Demographics
NPI:1396988648
Name:WEINZAPFEL-DICK, MARTHA L (ACNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:WEINZAPFEL-DICK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:L
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP
Mailing Address - Street 1:1401 PROFESSIONAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8011
Mailing Address - Country:US
Mailing Address - Phone:812-491-6419
Mailing Address - Fax:812-491-6465
Practice Address - Street 1:1312 PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8007
Practice Address - Country:US
Practice Address - Phone:812-491-6419
Practice Address - Fax:812-491-6465
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008090363LA2100X, 364SA2100X
IN71002918A363LA2100X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200990730Medicaid