Individual
MRS. ELIZABETH ANNE WEATHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
102 N COUNTY ROAD 800 E, SULLIVAN, IN 47882-7402
(812) 648-2455
Mailing address
102 N COUNTY ROAD 800 E, SULLIVAN, IN 47882-7402
(812) 648-2455
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
06003865A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1959
—
IN
Enumeration date
10/27/2011
Last updated
10/27/2011
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