Provider Demographics
NPI:1104210715
Name:CARDONA WEESE, BEATRICE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:
Last Name:CARDONA WEESE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:BEATRICE
Other - Middle Name:
Other - Last Name:CARDONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:578 N LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1131
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:
Practice Address - Street 1:1120 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6306
Practice Address - Country:US
Practice Address - Phone:440-365-2600
Practice Address - Fax:440-366-5543
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17181-NP363LF0000X
OHRN.351285-COA1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200965Medicaid
OH0265104Medicaid
OH0200965Medicaid
OHH482922Medicare PIN