Provider Demographics
NPI:1639676448
Name:WEIBEL, ANNELIESE
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:
Last Name:WEIBEL
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 1:112 VERA CIR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8778
Mailing Address - Country:US
Mailing Address - Phone:585-447-4960
Mailing Address - Fax:
Practice Address - Street 1:112 VERA CIR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8778
Practice Address - Country:US
Practice Address - Phone:585-447-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY681534163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health