Provider Demographics
NPI:1326346057
Name:WEINHOLD, GENA MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:MARIE
Last Name:WEINHOLD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 OLD SAINT MARYS RD
Mailing Address - Street 2:A
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1837
Mailing Address - Country:US
Mailing Address - Phone:573-547-3232
Mailing Address - Fax:
Practice Address - Street 1:624 OLD SAINT MARYS RD
Practice Address - Street 2:A
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1837
Practice Address - Country:US
Practice Address - Phone:573-547-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008688363LF0000X
MO2012024136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily