Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist | MT21003551 | IN |
NPI | 1528497260 |
---|---|
Provider Name | Jamie Weaver |
First Address | Mooresville, IN 46158-1781 |
Second Address | Mooresville, IN 46158-1781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2013 |
Last Update Date | 04/11/2013 |