Provider Demographics
NPI:1619280666
Name:THE PEOPLE'S CLINIC
Entity Type:Organization
Organization Name:THE PEOPLE'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC
Authorized Official - Phone:574-361-9338
Mailing Address - Street 1:5218 BECK DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9121
Mailing Address - Country:US
Mailing Address - Phone:574-361-9338
Mailing Address - Fax:
Practice Address - Street 1:5218 BECK DR
Practice Address - Street 2:SUITE 12
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9121
Practice Address - Country:US
Practice Address - Phone:574-361-9338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002758A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty