Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DS040709 | PA |
NPI | 1386089431 |
---|---|
Provider Name | Dr. Breanna M Weiland |
First Address | Nicktown, PA 15762-8605 |
Second Address | Nicktown, PA 15762-8605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 29/07/2016 |