Provider Demographics
NPI:1407514573
Name:WEINAND, CARENE EMMETT
Entity Type:Individual
Prefix:
First Name:CARENE
Middle Name:EMMETT
Last Name:WEINAND
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 1:50 STAFFORD BND
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5469
Mailing Address - Country:US
Mailing Address - Phone:307-689-0092
Mailing Address - Fax:
Practice Address - Street 1:1013 E BOXELDER RD STE 200
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5941
Practice Address - Country:US
Practice Address - Phone:307-257-7620
Practice Address - Fax:307-257-7618
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY48952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily