Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | LA |
NPI | 1184628968 |
---|---|
Provider Name | Melanie Weaver |
First Address | Opelousas, LA 70571-1389 |
Second Address | Opelousas, LA 70570-6549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1565300 | (05) | LA |