Jacqueline Deborah Weidauer, CNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

CP001487 Issued in SD

Practice address

1600 W 22ND St
Sioux Falls, SD 57105-1521

Phone

(605) 312-1000

NPI assigned

Nov 1, 2018

Last updated

Oct 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sanford Clinic

  dba Sanford Health Psychiatry & Psychology Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254

  Nurse Practitioner

  Medicare reassignment NPD
• Sanford Medical Center

  dba Edith Sanford Breast Specialty Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1093090342

  Nurse Practitioner

  Medicare reassignment NPD
• Sanford Clinic

  dba Sanford Clinic Family Medicine Sanford Campus MB1

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1285738997
  NPD
• Sanford Clinic

  dba Sanford Virtual Health Services

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1548737018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051521",
            "telephone_number": "605-312-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051521",
            "country_code": "US",
            "telephone_number": "605-328-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEIDAUER",
        "first_name": "JACQUELINE",
        "middle_name": "DEBORAH",
        "credential": "CNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-01",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP001487",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "SD",
            "license": "CP001487",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weerheim Specific, Inc. (Upper Cervical Health Center)
• Casey Weerheim, D.C.
• Lori Jane Wegehaupt, RN, MS, CNP
• Antonios Wehbeh, M.D.
• Henry Haoyu Wei, MD
• Kayla Weidenaar, RBT
• Charles Weiler
• Edwin Fredrick Weiler Jr., M.D.
• Neil D Weiler, D.C.
• Donna J Weinacht, M.D.

• Nurse Practitioner in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.