Provider Demographics
NPI:1518220995
Name:WEEDER, JAMIE LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:WEEDER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:RANCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-3774
Practice Address - Country:US
Practice Address - Phone:570-271-6045
Practice Address - Fax:570-271-6542
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN596183363L00000X
PASP012166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner