Provider Demographics
NPI:1457403743
Name:WEINBERG, LINDA R (CRNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N LAUREL ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5948
Mailing Address - Country:US
Mailing Address - Phone:570-459-0029
Mailing Address - Fax:570-454-5757
Practice Address - Street 1:20 N LAUREL ST STE 2A
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5948
Practice Address - Country:US
Practice Address - Phone:570-459-0029
Practice Address - Fax:570-454-5757
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006044B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064654V4CMedicare PIN
PA064654YG9CMedicare PIN
PAP73084Medicare UPIN