Provider Demographics
NPI:1477115491
Name:WEIMER, JOSEPH ALEXANDER (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:WEIMER
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 1:2160 E HIDDEN CREEK CT APT 205
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4412
Mailing Address - Country:US
Mailing Address - Phone:262-378-0275
Mailing Address - Fax:
Practice Address - Street 1:2160 E HIDDEN CREEK CT APT 205
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4412
Practice Address - Country:US
Practice Address - Phone:262-378-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194025-30163W00000X
WI10039-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse