Provider Demographics
NPI:1336228956
Name:WEILAND, KIM LESLIE (RN, CMF)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LESLIE
Last Name:WEILAND
Suffix:
Gender:F
Credentials:RN, CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ALTA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ALTA
Mailing Address - State:IA
Mailing Address - Zip Code:51002-1437
Mailing Address - Country:US
Mailing Address - Phone:712-200-2134
Mailing Address - Fax:
Practice Address - Street 1:501 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:ALTA
Practice Address - State:IA
Practice Address - Zip Code:51002-1437
Practice Address - Country:US
Practice Address - Phone:712-200-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0634871744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management