Basic Information
| Provider Information | |||||||||
| NPI: | 1396112926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIMER | ||||||||
| FirstName: | CONDA | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 CALVARY LN | ||||||||
| Address2: | |||||||||
| City: | PUNXSUTAWNEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157677937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142430521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 E DUBOIS AVE | ||||||||
| Address2: | |||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158013605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143716164 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA057768 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.