Provider Demographics
NPI:1114271459
Name:WEIS, JANE MANIO (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MANIO
Last Name:WEIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16111 N BRINSON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5509
Mailing Address - Country:US
Mailing Address - Phone:208-468-9400
Mailing Address - Fax:
Practice Address - Street 1:16111 N BRINSON ST STE 110
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5509
Practice Address - Country:US
Practice Address - Phone:208-468-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2019367A00000X
ID66A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife