Individual
KATHLEEN B WEIMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-6150
(901) 685-6454
Mailing address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-6150
(901) 685-6454
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000094606
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3622391
—
TN
01
—
4072551
BLUECROSS BLUESHIELD
TN
01
—
430065684
RAILROAD MEDICARE
TN
01
—
621839766
RIDGELAKE TAX ID#
TN
Enumeration date
02/27/2007
Last updated
11/15/2010
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