Provider Demographics
NPI:1891292561
Name:WEIS, NICHOLAS (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:WEIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SHELL EDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4356
Mailing Address - Country:US
Mailing Address - Phone:585-359-5413
Mailing Address - Fax:
Practice Address - Street 1:85 SHELL EDGE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4356
Practice Address - Country:US
Practice Address - Phone:585-359-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682128163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool