Provider Demographics
NPI:1649307778
Name:WEISS WUERTH, JANA D (APRN, MSN, CS)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:D
Last Name:WEISS WUERTH
Suffix:
Gender:F
Credentials:APRN, MSN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRAVES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2647
Mailing Address - Country:US
Mailing Address - Phone:203-458-1970
Mailing Address - Fax:
Practice Address - Street 1:2 GRAVES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2626
Practice Address - Country:US
Practice Address - Phone:203-458-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000848163WP0809X
CTR32645163WP0809X
CT100281163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400R32645CT02Medicare UPIN