Provider Demographics
NPI:1841367315
Name:WEISENBECK, JOAN ELLEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELLEN
Last Name:WEISENBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:320 STOKES RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8370
Mailing Address - Country:US
Mailing Address - Phone:336-349-7114
Mailing Address - Fax:336-361-0022
Practice Address - Street 1:601 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4621
Practice Address - Country:US
Practice Address - Phone:336-349-3332
Practice Address - Fax:336-361-0022
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical