Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 42582 | MN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 42582 | MN |
NPI | 1194779850 |
---|---|
Provider Name | Dr. Brenda Jane Weigel |
First Address | Minneapolis, MN 55414 |
Second Address | Minneapolis, MN 55455-0341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 01/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050958200 | (05) | MN |
H23078 | (02) | MN |