Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 12924 | NH |
NPI | 1023094083 |
---|---|
Provider Name | Jennifer W Weidner |
First Address | Bedford, NH 03110-6763 |
Second Address | Bedford, NH 03110-6763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30205654 | (05) | NH |
I33946 | (02) | NH |