Provider Demographics
NPI:1366478752
Name:WEISSBURG, ANITA JANE (CRNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JANE
Last Name:WEISSBURG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1228 FENWICK GARTH
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2107
Mailing Address - Country:US
Mailing Address - Phone:410-263-6363
Mailing Address - Fax:410-263-4086
Practice Address - Street 1:200 FORBES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1538
Practice Address - Country:US
Practice Address - Phone:410-263-6363
Practice Address - Fax:410-263-4086
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR071068363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP31862Medicare UPIN