| NPI | 1154792406 |
|---|---|
| Former Name | SHARA ANN MARISSA WEIDACHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013195) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A181345) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2025-04-22 |