Healthcare Provider Details

I. General information

NPI: 1225136393
Provider Name (Legal Business Name): JEAN H WEBLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVENUE
MIAMI-DADE FL
33136
US

IV. Provider business mailing address

4898 SW 183RD AVE
MIRAMAR FL
33029-6321
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5116
  • Fax:
Mailing address:
  • Phone: 954-437-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0969702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: