Provider Demographics
NPI:1609964162
Name:WEIDLER, CAROL S (APRN, WHNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:WEIDLER
Suffix:
Gender:F
Credentials:APRN, WHNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:S
Other - Last Name:STRAWKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:900 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3749
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-525-0121
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000584363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72353Medicare UPIN
K24289Medicare ID - Type Unspecified