Healthcare Provider Details

I. General information

NPI: 1164698304
Provider Name (Legal Business Name): KIRSTIN DARCIE WEERDENBURG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVENUE CLEVELAND CLINIC
CLEVELAND OH
44195
US

IV. Provider business mailing address

7087 RIDGEWOOD CRES
NIAGARA FALLS ONTARIO
L2J2C2
CA

V. Phone/Fax

Practice location:
  • Phone: 216-444-5510
  • Fax:
Mailing address:
  • Phone: 905-358-8201
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: