Provider Demographics
NPI:1447795414
Name:WEIR, JOELLE ELISE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:ELISE
Last Name:WEIR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:ELISE
Other - Last Name:VAN VALKENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 ST. FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:952-428-3535
Mailing Address - Fax:952-428-3599
Practice Address - Street 1:1601 ST. FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-428-3535
Practice Address - Fax:952-428-3599
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6383363L00000X
IL209.015403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner