Individual
MR. JOHN RICHARD WEISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
99 CHURCH STREET, WARE, MA 01082
(508) 397-7350
Mailing address
99 CHURCH STREET, WARE, MA 01082
(508) 397-7350
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
44386
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0711586
PROVIDER
MA
01
—
PT61
MA HEALTH
—
Enumeration date
10/17/2007
Last updated
10/17/2007
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