Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 2010017748 | MO |
Y | 2080P0006X | Developmental - Behavioral Pediatrician | 036141017 | IL |
NPI | 1164733440 |
---|---|
Provider Name | Erica Dawn Wiebe |
First Address | Urbana, IL 61801-2500 |
Second Address | Champaign, IL 61822-9678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 08/09/2016 |