Doctor Name: | ELISE REBECCA WEICHBRODT |
NPI Number: | 1053769406 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 95004384 |
Business Practice Address: | 27875 Smyth Dr Suite 101 Valencia, CA - 913556063 |
Business Phone Number: | 6617021440 |
Business Fax Number: | |
Mailing Address: | 27875 Smyth Dr, Suite 101 VALENCIA |
State: | CA |
Postal Code: | 913556063 |
Phone Number: | 6617021440 |
Fax Number: | |
NPI Enumeration Date: | 05/26/2016 |
NPI Last Update Date: | 05/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 95004384 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |