Provider Demographics
NPI:1336158013
Name:WEILAND, TERRI E (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:E
Last Name:WEILAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 WOOSTER RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1568
Mailing Address - Country:US
Mailing Address - Phone:330-674-3434
Mailing Address - Fax:330-674-3731
Practice Address - Street 1:1261 WOOSTER RD
Practice Address - Street 2:SUITE 230
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1568
Practice Address - Country:US
Practice Address - Phone:330-674-3434
Practice Address - Fax:330-674-3731
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S76053Medicare UPIN