Basic Information
| Provider Information | |||||||||
| NPI: | 1578513172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEYGANDT | ||||||||
| FirstName: | VERNON | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 HAYS HILL DR | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630263159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363264716 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 HAYS HILL DR | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630263159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363264716 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 063885 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.