Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7855-33 | WI |
NPI | 1003334350 |
---|---|
Provider Name | Jonathan Weimer |
First Address | Milwaukee, WI 53203-1802 |
Second Address | Milwaukee, WI 53203-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |