Provider Demographics
NPI:1134406853
Name:WEEKLEY NINO, STEPHANIE N (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:WEEKLEY NINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:N
Other - Last Name:WEEKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:87 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1127
Mailing Address - Country:US
Mailing Address - Phone:724-938-7000
Mailing Address - Fax:724-938-3390
Practice Address - Street 1:87 3RD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1127
Practice Address - Country:US
Practice Address - Phone:724-938-7000
Practice Address - Fax:724-938-3390
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055242363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical