Provider Demographics
NPI:1578215364
Name:WEISS, FOSHAH L
Entity Type:Individual
Prefix:
First Name:FOSHAH
Middle Name:L
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-5014
Mailing Address - Country:US
Mailing Address - Phone:937-603-9927
Mailing Address - Fax:
Practice Address - Street 1:113 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-5014
Practice Address - Country:US
Practice Address - Phone:937-603-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160955.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse