Individual
JESSICA WEIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16288 PARKVIEW DR SE, PRIOR LAKE, MN 55372-3314
(952) 447-7260
Mailing address
16288 PARKVIEW DR SE, PRIOR LAKE, MN 55372-3314
(952) 447-7260
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/20/2021
Last updated
12/22/2022
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