Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 01040182 | IN |
NPI | 1093772378 |
---|---|
Provider Name | Denise C Weaver |
First Address | Merrillville, IN 46410-7032 |
Second Address | Hobart, IN 46342-6791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100361920 | (05) | IN |
E18325 | (02) |