Individual
EKATERINA SUE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
60101 BODNAR BLVD STE 100B, MISHAWAKA, IN 46544-9340
(574) 335-8500
(574) 335-0794
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28243181A
IN
Other
Enumeration date
12/07/2023
Last updated
01/26/2024
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