Provider Demographics
NPI:1881836179
Name:WEIDNER, PATRICIA K
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:K
Last Name:WEIDNER
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 1:42 W LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-8961
Mailing Address - Country:US
Mailing Address - Phone:765-395-7149
Mailing Address - Fax:
Practice Address - Street 1:42 W LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-8961
Practice Address - Country:US
Practice Address - Phone:765-395-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ ID 69947343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)