Provider Demographics
NPI:1427284298
Name:WEISS, JAN R (CRNP)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:R
Last Name:WEISS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 HAMILTON BLVD REAR
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-9100
Mailing Address - Country:US
Mailing Address - Phone:610-481-0481
Mailing Address - Fax:610-481-0486
Practice Address - Street 1:316 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1949
Practice Address - Country:US
Practice Address - Phone:610-481-0481
Practice Address - Fax:610-481-0486
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN197603L163W00000X
PASP000581G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse