Provider Demographics
NPI:1780577544
Name:WEIDNER, CHRISMA THERCIA
Entity type:Individual
Prefix:MRS
First Name:CHRISMA
Middle Name:THERCIA
Last Name:WEIDNER
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 1:368 79TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:HALLIDAY
Mailing Address - State:ND
Mailing Address - Zip Code:58636-9770
Mailing Address - Country:US
Mailing Address - Phone:701-400-1555
Mailing Address - Fax:
Practice Address - Street 1:368 79TH AVE NW
Practice Address - Street 2:
Practice Address - City:HALLIDAY
Practice Address - State:ND
Practice Address - Zip Code:58636-9770
Practice Address - Country:US
Practice Address - Phone:701-400-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider