Provider Demographics
NPI:1083297626
Name:WEIMAN, KAITLYN LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LEE
Last Name:WEIMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:LEE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 HEDGEWICK LN
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17368-9159
Mailing Address - Country:US
Mailing Address - Phone:717-430-1258
Mailing Address - Fax:
Practice Address - Street 1:306 N 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-2137
Practice Address - Country:US
Practice Address - Phone:717-684-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily