Individual
JAMIE LYNN WEIDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9347 PENDLETON PIKE, INDIANAPOLIS, IN 46236-2768
(317) 612-3193
(317) 612-3270
Mailing address
9347 PENDLETON PIKE, INDIANAPOLIS, IN 46236-2768
(317) 612-3196
(317) 612-3270
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71003106A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000638748
ANTHEM BCBS
IN
05
—
200960050
—
IN
Enumeration date
09/30/2009
Last updated
09/24/2014
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