Provider Demographics
NPI:1184405029
Name:WEISS, ELISA ANN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:ANN
Last Name:WEISS
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:MOON
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2915 CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1412
Mailing Address - Country:US
Mailing Address - Phone:360-661-8111
Mailing Address - Fax:
Practice Address - Street 1:2915 CEDARWOOD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1412
Practice Address - Country:US
Practice Address - Phone:360-661-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61451008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist