Doctor Name: | TIMOTHY ROBERT WEBER |
NPI Number: | 1386005601 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | CNP 4335 |
Business Practice Address: | 512 Skyline Blvd Cloquet, MN - 55720 |
Business Phone Number: | 2188794641 |
Business Fax Number: | |
Mailing Address: | 609 E 3rd St, SUPERIOR |
State: | WI |
Postal Code: | 548803150 |
Phone Number: | 2182603350 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2016 |
NPI Last Update Date: | 03/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CNP 4335 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |