Provider Demographics
NPI:1801210240
Name:WEIGNER, GLENDA (APNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:WEIGNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1241
Mailing Address - Country:US
Mailing Address - Phone:920-846-3444
Mailing Address - Fax:920-846-0250
Practice Address - Street 1:835 S MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1282
Practice Address - Country:US
Practice Address - Phone:920-846-8187
Practice Address - Fax:920-846-2073
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5671-33363L00000X
WI137624-30363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11014110Medicaid
WA1851477913OtherCMH NPI
WI00439Medicare PIN
WA1851477913OtherCMH NPI
WI521310Medicare Oscar/Certification
WIK400295179Medicare Oscar/Certification