Provider Demographics
NPI:1952711251
Name:WEIMER-REDSICKER, TESSA
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:WEIMER-REDSICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13144-4461
Mailing Address - Country:US
Mailing Address - Phone:315-480-0419
Mailing Address - Fax:
Practice Address - Street 1:439 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:NY
Practice Address - Zip Code:13144-4461
Practice Address - Country:US
Practice Address - Phone:315-480-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist