| Doctor Name: | EDITH ELAINE WEATHERFORD |
| NPI Number: | 1063404804 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 4704161015 |
| Business Practice Address: | 1414 W Fair Ave #226 Marquette, MI - 498552675 |
| Business Phone Number: | 9062253925 |
| Business Fax Number: | 9062254838 |
| Mailing Address: | 1414 W Fair Ave, #226 MARQUETTE |
| State: | MI |
| Postal Code: | 498552675 |
| Phone Number: | 9062253925 |
| Fax Number: | 9062254838 |
| NPI Enumeration Date: | 08/18/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4704161015 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |