Provider Demographics
NPI:1306581319
Name:WEINE, ERIENNE (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIENNE
Middle Name:
Last Name:WEINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:FORT GARLAND
Mailing Address - State:CO
Mailing Address - Zip Code:81133-0051
Mailing Address - Country:US
Mailing Address - Phone:520-604-3624
Mailing Address - Fax:
Practice Address - Street 1:555 SMITH RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4139
Practice Address - Country:US
Practice Address - Phone:520-603-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach