Healthcare Provider Details

I. General information

NPI: 1366206740
Provider Name (Legal Business Name): EMMA WESTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W MICHIGAN AVE
KALAMAZOO MI
49006-5810
US

IV. Provider business mailing address

503 W 2ND AVE
COLUMBUS OH
43201-3357
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-1200
  • Fax: 734-926-8987
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704385017
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: