Provider Demographics
NPI:1205645843
Name:WEISENBURGER, MARK
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:WEISENBURGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 W VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9585
Mailing Address - Country:US
Mailing Address - Phone:801-358-6106
Mailing Address - Fax:
Practice Address - Street 1:4785 W VISTA DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9585
Practice Address - Country:US
Practice Address - Phone:801-358-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care