Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | LP60816254 | WA |
NPI | 1003458548 |
---|---|
Provider Name | Heidi A Weitzel |
First Address | Spokane, WA 99208-6514 |
Second Address | Spokane, WA 99208-6514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2019 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2077844 | (05) | WA |