Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NN08641300 | NJ |
NPI | 1003993387 |
---|---|
Provider Name | Elfie Wegner |
First Address | Boston, MA 02241-6457 |
Second Address | Summit, NJ 07901-3570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/02/2022 |