Provider Demographics
NPI:1023693140
Name:WELLER, ANNETTE (CNM)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:WELLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24598 SADDLEBACK DR
Mailing Address - Street 2:
Mailing Address - City:HERMOSA
Mailing Address - State:SD
Mailing Address - Zip Code:57744-6005
Mailing Address - Country:US
Mailing Address - Phone:605-209-2197
Mailing Address - Fax:605-646-2578
Practice Address - Street 1:24598 SADDLEBACK DR
Practice Address - Street 2:
Practice Address - City:HERMOSA
Practice Address - State:SD
Practice Address - Zip Code:57744-5774
Practice Address - Country:US
Practice Address - Phone:605-209-2197
Practice Address - Fax:605-646-2578
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCM000085176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife