Provider Demographics
NPI:1275004897
Name:WEIDEMAN, TANYA LYNN (APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:WEIDEMAN
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 TOWN HALL RD
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-5803
Mailing Address - Country:US
Mailing Address - Phone:715-307-7553
Mailing Address - Fax:715-425-0438
Practice Address - Street 1:1752 DORSET LN
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2452
Practice Address - Country:US
Practice Address - Phone:715-307-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2108214163W00000X
WI0193509163WH0200X
WI15090332084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry