Provider Demographics
NPI:1316507825
Name:WEBER, SUSAN A
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 CHATHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-5931
Mailing Address - Country:US
Mailing Address - Phone:509-679-4890
Mailing Address - Fax:
Practice Address - Street 1:313 CHATHAM HILL RD
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-5931
Practice Address - Country:US
Practice Address - Phone:509-679-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0014680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine