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General NPI Number Information
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NPI Number | 1366616716
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Entity Type | Organization
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Legal Business Name | THERESA WEILAND DO PA
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 222 N 2ND ST SUITE 201
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City | BOISE
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State | ID
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Zip | 83702-6109
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Country | US
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Telephone | 208-345-7727
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Fax | 208-345-4689
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Provider Business Mailing Address
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Address Line | 2245 TOLUKA WAY
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City | BOISE
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State | ID
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Zip | 83712-8552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORP SECRETARY
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Name | STEVEN CSIK
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Credential |
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Telephone | 208-333-8841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-119
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License Number State | ID
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