Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3015128 | KY |
NPI | 1003422270 |
---|---|
Provider Name | Victoria Weis |
First Address | Prospect, KY 40059-7585 |
Second Address | Prospect, KY 40059-7585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2020 |
Last Update Date | 22/09/2020 |