Provider Demographics
NPI:1033654702
Name:WEINGARTZ, JANE SUSAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:SUSAN
Last Name:WEINGARTZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:SUSAN
Other - Last Name:WALIGORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 W SAINT CLAIR ST
Mailing Address - Street 2:PO BOX 124
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-8445
Mailing Address - Country:US
Mailing Address - Phone:810-338-3508
Mailing Address - Fax:
Practice Address - Street 1:1457 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1151
Practice Address - Country:US
Practice Address - Phone:810-245-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily