Provider Demographics
NPI:1487705851
Name:WEISS, DEBRA RENE (LAC, RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENE
Last Name:WEISS
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 HADLEY AVE N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5951
Mailing Address - Country:US
Mailing Address - Phone:651-235-7324
Mailing Address - Fax:
Practice Address - Street 1:1075 HADLEY AVE N
Practice Address - Street 2:SUITE 106
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5951
Practice Address - Country:US
Practice Address - Phone:651-235-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN96104OtherHEALTHPARTNERS PROVIDER