Provider Demographics
NPI:1669836631
Name:WESTON, JOANNE (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:WESTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 N PERSHING AVE
Mailing Address - Street 2:A-1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4942
Mailing Address - Country:US
Mailing Address - Phone:209-946-4373
Mailing Address - Fax:209-946-4741
Practice Address - Street 1:5713 N PERSHING AVE
Practice Address - Street 2:A-1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4942
Practice Address - Country:US
Practice Address - Phone:209-946-4373
Practice Address - Fax:209-946-4741
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily