Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71000775 | IN |
NPI | 1013094994 |
---|---|
Provider Name | Heather Weber |
First Address | Peru, IN 46970-9057 |
Second Address | Peru, IN 46970-9057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200375910 | (05) | IN |