Provider Demographics
NPI:1780424242
Name:WEBER, MYAH ELIZABETH LEE
Entity type:Individual
Prefix:
First Name:MYAH
Middle Name:ELIZABETH LEE
Last Name:WEBER
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 1:4912 MORTENSEN RD UNIT 131
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-6201
Mailing Address - Country:US
Mailing Address - Phone:319-939-4382
Mailing Address - Fax:
Practice Address - Street 1:18 JACK TRICE WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-0001
Practice Address - Country:US
Practice Address - Phone:515-294-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program