Provider Demographics
NPI:1336146075
Name:WEISENBERGER, EDWARD JOHN (CRNA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:WEISENBERGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:614-566-6366
Mailing Address - Fax:614-566-6370
Practice Address - Street 1:111 S GRANT AVE
Practice Address - Street 2:3RD FL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-566-8808
Practice Address - Fax:614-566-9503
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHNA00398367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered