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Individual

ANNA GRACE WEASENFORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AUD

Contact information

Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-8868
Mailing address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-8868

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002589A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
188JS
BCBS
NC
01
Q47704A
MEDICARE
NC
05
SAN121
SC
Enumeration date
08/07/2014
Last updated
12/22/2017
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