Provider Demographics
NPI:1760039663
Name:WEIDMAN, LAUREN PAIGE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PAIGE
Last Name:WEIDMAN
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 1:4808 N 24TH ST UNIT 430
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9123
Mailing Address - Country:US
Mailing Address - Phone:520-901-0556
Mailing Address - Fax:
Practice Address - Street 1:4808 N 24TH ST UNIT 430
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-9123
Practice Address - Country:US
Practice Address - Phone:520-901-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-25
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical