Provider Demographics
NPI:1265487748
Name:WEISHOLTZ, KYLE DIANE (MSN APN-C)
Entity Type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:DIANE
Last Name:WEISHOLTZ
Suffix:
Gender:F
Credentials:MSN APN-C
Other - Prefix:MISS
Other - First Name:KYLE
Other - Middle Name:D
Other - Last Name:RINEHART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:36 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-408-3414
Mailing Address - Fax:973-408-3031
Practice Address - Street 1:36 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-408-3414
Practice Address - Fax:973-408-3031
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N00088700363LA2200X
NJ26NJ00088700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ50892Medicare UPIN
NJ094102Medicare ID - Type UnspecifiedPROVIDER INDENTIFICATION