Provider Demographics
NPI:1497056113
Name:WEDBERG SIVAM, ELIZABETH A (RN, MSN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:WEDBERG SIVAM
Suffix:
Gender:F
Credentials:RN, MSN, ACNS-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WEDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, ACNS-BC
Mailing Address - Street 1:1600 W 38TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6405
Mailing Address - Country:US
Mailing Address - Phone:512-324-3540
Mailing Address - Fax:512-324-3512
Practice Address - Street 1:1600 W 38TH ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6405
Practice Address - Country:US
Practice Address - Phone:512-324-3540
Practice Address - Fax:512-324-3512
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747238364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health