Provider Demographics
NPI:1134852502
Name:WEYEN, JENNA ANN (NP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:WEYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ANN
Other - Last Name:POTTEBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:318 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRETON
Mailing Address - State:IA
Mailing Address - Zip Code:51027-7761
Mailing Address - Country:US
Mailing Address - Phone:712-551-1011
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRETON
Practice Address - State:IA
Practice Address - Zip Code:51027-7761
Practice Address - Country:US
Practice Address - Phone:712-551-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA169847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily