Provider Demographics
NPI:1730143348
Name:WEESE, NANCY E
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:WEESE
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 1:660 ACKERMAN 3RD FLOOR
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 WEST TENTH AVENUE
Practice Address - Street 2:DEPT OF NUTRITION 9-07 RHODES HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-2300
Practice Address - Fax:614-293-3740
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWEMT02991Medicare PIN