Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN183460 | GA |
NPI | 1255832994 |
---|---|
Provider Name | Alisha Benson Weathers |
First Address | Soddy Daisy, TN 37379-3469 |
Second Address | Dalton, GA 30720-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2018 |
Last Update Date | 29/03/2021 |