Provider Demographics
NPI:1407895030
Name:WEINERTH, SCOTT JEFFREY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JEFFREY
Last Name:WEINERTH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 DEL PRADO BLVD S
Mailing Address - Street 2:208
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5788
Mailing Address - Country:US
Mailing Address - Phone:239-233-6749
Mailing Address - Fax:
Practice Address - Street 1:6122 TERRI LYNN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-1678
Practice Address - Country:US
Practice Address - Phone:314-352-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered