Healthcare Provider Details

I. General information

NPI: 1922932516
Provider Name (Legal Business Name): ELISE WEIR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14455 W VAN BUREN ST # 100
GOODYEAR AZ
85338-9209
US

IV. Provider business mailing address

15501 N DIAL BLVD UNIT 3017
SCOTTSDALE AZ
85260-2253
US

V. Phone/Fax

Practice location:
  • Phone: 952-454-8721
  • Fax:
Mailing address:
  • Phone: 952-454-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: