Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 11010934A | IN |
N | 2080P0208X | Pediatric Infectious Diseases | 01066580 | IN |
NPI | 1487811915 |
---|---|
Provider Name | Dr. Bree Ashley Weaver |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200959990 | (05) | IN |