Individual
MRS. KHONNAH WEITHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
621 MEMORIAL DR, SUITE 512, SOUTH BEND, IN 46601-1063
(574) 246-9350
Mailing address
621 MEMORIAL DR STE 512, SOUTH BEND, IN 46601-1075
(574) 246-9350
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007029A
IN
Other
Enumeration date
04/10/2017
Last updated
03/26/2018
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