Provider Demographics
NPI:1538850359
Name:WEIKLE, JENNIFER B
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:WEIKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8942 SENECA TRL S
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8374
Mailing Address - Country:US
Mailing Address - Phone:130-464-5747
Mailing Address - Fax:304-645-7799
Practice Address - Street 1:8942 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8374
Practice Address - Country:US
Practice Address - Phone:130-464-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62173163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse