Provider Demographics
NPI:1902807837
Name:WEISSER, NADINE (MD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:WEISSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4302
Mailing Address - Country:US
Mailing Address - Phone:269-979-6342
Mailing Address - Fax:269-979-6435
Practice Address - Street 1:3238 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4302
Practice Address - Country:US
Practice Address - Phone:269-979-6342
Practice Address - Fax:269-979-6435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINW043389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4737221Medicaid
MI1601311071OtherBCN
MI1601311071OtherBCBSM
MIOM80790003Medicare ID - Type Unspecified
MI4737221Medicaid