Provider Demographics
NPI:1679261366
Name:WEBER, SANSAN (CRNP)
Entity type:Individual
Prefix:
First Name:SANSAN
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9824
Mailing Address - Country:US
Mailing Address - Phone:610-858-0241
Mailing Address - Fax:
Practice Address - Street 1:645 PENN ST FL 2
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3543
Practice Address - Country:US
Practice Address - Phone:610-373-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA733018163W00000X
PASP027676363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse