Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-138046 | AL |
NPI | 1003402033 |
---|---|
Provider Name | Heather Weller |
First Address | Mountain Brk, AL 35223-1710 |
Second Address | Birmingham, AL 35233-1932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2020 |
Last Update Date | 14/12/2020 |