Basic Information
| Provider Information | |||||||||
| NPI: | 1043855760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISMAN | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| OtherLastName: | WEISMAN | ||||||||
| OtherFirstName: | ANNIE | ||||||||
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| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14420 WISCONSIN AVE | ||||||||
| Address2: | |||||||||
| City: | ELM GROVE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531222432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076902421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5409 VERN HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544828853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153441600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2019 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 4859-23 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.