Provider Demographics
NPI:1295492908
Name:WEIGEL, MADYSEN (APRN)
Entity type:Individual
Prefix:
First Name:MADYSEN
Middle Name:
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MADYSEN
Other - Middle Name:TAYLER
Other - Last Name:WEIGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18713 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-8865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2708 STERNBERG DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2057
Practice Address - Country:US
Practice Address - Phone:785-625-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80668363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner