Provider Demographics
NPI:1447409305
Name:WEIERMAN, AMY (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEIERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GALIPEAU; IVANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE WITH THESE NAME
Mailing Address - Street 1:1916 PASEO SAN LUIS
Mailing Address - Street 2:COCHISE DERMATOLOGY
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4614
Mailing Address - Country:US
Mailing Address - Phone:520-458-1505
Mailing Address - Fax:
Practice Address - Street 1:1916 PASEO SAN LUIS
Practice Address - Street 2:COCHISE DERMATOLOGY
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4614
Practice Address - Country:US
Practice Address - Phone:520-458-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003299363A00000X
AZ5368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant