Provider Demographics
NPI:1881218592
Name:WEBER, AUDREY (PA-C)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:SMEENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:23205 HILL TOP DR
Mailing Address - Street 2:
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-3229
Mailing Address - Country:US
Mailing Address - Phone:605-441-8202
Mailing Address - Fax:
Practice Address - Street 1:503 W PINE ST
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-3300
Practice Address - Country:US
Practice Address - Phone:605-859-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant