Provider Demographics
NPI:1780361105
Name:WEIGMAN, CARRIE JO (DNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:WEIGMAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16862 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6435
Mailing Address - Country:US
Mailing Address - Phone:763-439-3710
Mailing Address - Fax:
Practice Address - Street 1:110 OLSEN BLVD NE
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4359
Practice Address - Country:US
Practice Address - Phone:320-286-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10658363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care