Individual
MADONNA WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1105 W LIBERTY ST, SUITE 4050, FARMINGTON, MO 63640-1921
(573) 756-7844
(573) 756-9597
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(573) 756-7844
(573) 756-9597
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
070291
MO
363LF0000X
Family Nurse Practitioner
Primary
070291
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425285707
—
MO
Enumeration date
09/13/2006
Last updated
10/09/2014
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