Provider Demographics
NPI:1497382329
Name:WEISEL, WESLEY A
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:A
Last Name:WEISEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6291 JOLIAT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641
Mailing Address - Country:US
Mailing Address - Phone:330-316-7794
Mailing Address - Fax:
Practice Address - Street 1:6291 JOLIAT AVENUE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641
Practice Address - Country:US
Practice Address - Phone:330-316-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide