Provider Demographics
NPI:1578513172
Name:WEYGANDT, VERNON P (CRNA)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:P
Last Name:WEYGANDT
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 1:333 HAYS HILL DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3159
Mailing Address - Country:US
Mailing Address - Phone:636-326-4716
Mailing Address - Fax:
Practice Address - Street 1:333 HAYS HILL DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3159
Practice Address - Country:US
Practice Address - Phone:636-326-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO063885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered