Provider Demographics
NPI:1811408354
Name:WEISS, ANNA ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELAINE
Last Name:WEISS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DUANE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4306
Mailing Address - Country:US
Mailing Address - Phone:215-870-7255
Mailing Address - Fax:
Practice Address - Street 1:17 DUANE DR
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4306
Practice Address - Country:US
Practice Address - Phone:215-870-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330288-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse