Provider Demographics
NPI:1932107166
Name:WEISS, FAYE M (RN, CNS, MSN)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:M
Last Name:WEISS
Suffix:
Gender:F
Credentials:RN, CNS, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2462
Mailing Address - Country:US
Mailing Address - Phone:701-833-8158
Mailing Address - Fax:701-839-1312
Practice Address - Street 1:234 14TH AVE SE STE 317
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5981
Practice Address - Country:US
Practice Address - Phone:701-833-8158
Practice Address - Fax:701-839-1312
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26679364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14609Medicare ID - Type UnspecifiedMEDICARE
ND018851Medicare UPIN