Provider Demographics
NPI:1679322689
Name:WEISE, HALLE (PA-C)
Entity type:Individual
Prefix:
First Name:HALLE
Middle Name:
Last Name:WEISE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCA
Mailing Address - State:NE
Mailing Address - Zip Code:68430-4029
Mailing Address - Country:US
Mailing Address - Phone:402-806-9161
Mailing Address - Fax:
Practice Address - Street 1:202 HIGH ST STE 100
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2443
Practice Address - Country:US
Practice Address - Phone:402-335-2811
Practice Address - Fax:402-335-2826
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-09-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant