Provider Demographics
NPI:1659582872
Name:WEEDA, CHARLOTTE ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ESTHER
Last Name:WEEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:ESTHER
Other - Last Name:STILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-928-6383
Mailing Address - Fax:
Practice Address - Street 1:700 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE 155
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4462
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-625-2075
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD150157208000000X
WAMD60614530208000000X
IDM15362208000000X
IDM-15362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics