Provider Demographics
NPI:1750817904
Name:WEILACHER, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WEILACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:MAIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 YORK ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1412
Mailing Address - Country:US
Mailing Address - Phone:814-664-8886
Mailing Address - Fax:814-452-7005
Practice Address - Street 1:315 YORK ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1412
Practice Address - Country:US
Practice Address - Phone:814-664-8686
Practice Address - Fax:814-664-9826
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily