Provider Demographics
NPI:1528332301
Name:WEISKE, COLE JEFFREY (PA-C)
Entity type:Individual
Prefix:MR
First Name:COLE
Middle Name:JEFFREY
Last Name:WEISKE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3111 124TH AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4573
Mailing Address - Country:US
Mailing Address - Phone:763-427-7300
Mailing Address - Fax:763-427-2802
Practice Address - Street 1:3111 124TH AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4573
Practice Address - Country:US
Practice Address - Phone:763-427-7300
Practice Address - Fax:763-427-2802
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2017-10-02
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Provider Licenses
StateLicense IDTaxonomies
MN11109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant