Look up the most recent NPI and PECOS records

Nicole Weis

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

Based on the most recent information from CMS, provider Nicole Weis is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1760090666
Provider Type
Individual
Full Name
Weis, Nicole
Credential
PA-C

Gender
Female
Sole Proprietor
Yes
Enumeration Date
7/16/2020
Last Updated
9/13/2023

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-6813

(503) 494-1310

Mailing Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-6813

(503) 494-1310

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA201241 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Nicole Weis

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Friberg, Whitni Nicole

Smith, Parrish

Aby-Daniel, Diana

Ahmad, Zoha

Jensen, Amanda

Masterson, Rachael

Bunker, Matthew Alexander

Locicero, Stephanie

Ying, Monique M

Dang, Theresa Huong Tuyet Thi