| NPI | 1124394945 |
|---|---|
| Former Name | ELIZABETH ANN WEAGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301108540) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2019-03-25 |