Provider Demographics
NPI:1003325184
Name:WEISSER, CAROLINE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:WEISSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 CLOVERLEAF ROAD
Mailing Address - Street 2:
Mailing Address - City:ELIZATHEBTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9063
Mailing Address - Country:US
Mailing Address - Phone:717-544-6350
Mailing Address - Fax:717-544-6353
Practice Address - Street 1:1625 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4335
Practice Address - Country:US
Practice Address - Phone:717-925-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA059324363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant