Provider Demographics
NPI:1265839260
Name:WEISBERGBEYERLEIN, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:WEISBERGBEYERLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 VILLAGE GREEN DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5847
Mailing Address - Country:US
Mailing Address - Phone:425-244-8736
Mailing Address - Fax:
Practice Address - Street 1:15800 VILLAGE GREEN DR UNIT 3
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5847
Practice Address - Country:US
Practice Address - Phone:425-244-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00142515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse