Provider Demographics
NPI:1295162592
Name:WEIS, JAMIE KAYE (CPNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:KAYE
Last Name:WEIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KAYE
Other - Last Name:RINGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:4655 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4216
Mailing Address - Country:US
Mailing Address - Phone:773-685-3288
Mailing Address - Fax:773-685-7748
Practice Address - Street 1:4655 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4216
Practice Address - Country:US
Practice Address - Phone:773-685-3288
Practice Address - Fax:773-685-7748
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211084163WP0200X, 363LP0200X
VA0024174289363LP0200X
IL209020734363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics