Provider Demographics
NPI:1043515190
Name:WEIDEMOYER, LEAH G (CRNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:G
Last Name:WEIDEMOYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:817 LAWN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1579
Practice Address - Country:US
Practice Address - Phone:215-257-8391
Practice Address - Fax:215-453-6955
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP011121363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health