Individual
KATIE K WEINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085003686
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003686
STATE LICENSE
IL
Enumeration date
01/22/2010
Last updated
05/25/2021
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