Provider Demographics
NPI:1902838543
Name:WEIDNER, CARLA F (MSN CRNP BC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:F
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:MSN CRNP BC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:F
Other - Last Name:HENSELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13700-1432
Mailing Address - Street 2:GRAND VIEW EMERGENCY MEDICINE ASSOCIATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19191-1432
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:700 LAWN AVENUE
Practice Address - Street 2:GRANDVIEW HOSPITAL
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960
Practice Address - Country:US
Practice Address - Phone:215-453-4000
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005133B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69372Medicare UPIN
PA022604Medicare ID - Type Unspecified