Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | CM000085 | SD |
NPI | 1023693140 |
---|---|
Provider Name | Annette Weller |
First Address | Hermosa, SD 57744-6005 |
Second Address | Hermosa, SD 57744-5774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2021 |
Last Update Date | 10/03/2021 |