Provider Demographics
NPI:1417086075
Name:WEISS, MICKIE FRANCINE (APRN)
Entity Type:Individual
Prefix:
First Name:MICKIE
Middle Name:FRANCINE
Last Name:WEISS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:FRANCINE
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:13014 BENCHVIEW CV
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8966
Mailing Address - Country:US
Mailing Address - Phone:801-707-5248
Mailing Address - Fax:801-765-4386
Practice Address - Street 1:386 E 720 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6342
Practice Address - Country:US
Practice Address - Phone:801-225-2623
Practice Address - Fax:801-765-4386
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261008-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health