Provider Demographics
NPI:1386864221
Name:WEINBERG, ELISHA FAE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELISHA
Middle Name:FAE
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20307 VIKING AVE NW STE 103
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8321
Mailing Address - Country:US
Mailing Address - Phone:360-598-3206
Mailing Address - Fax:
Practice Address - Street 1:20307 VIKING AVE NW STE 103
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8321
Practice Address - Country:US
Practice Address - Phone:360-598-3206
Practice Address - Fax:360-930-0902
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist