Individual
MS. TAMARA JEAN WEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024164951
VA
367500000X
Certified Registered Nurse Anesthetist
053088
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
19381
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104882844
—
VA
01
—
562014989
TRICARE
NC
05
—
6907604
—
NC
Enumeration date
04/21/2006
Last updated
07/17/2015
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