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General NPI Number Information
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NPI Number | 1417765694
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Entity Type | Individual
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Provider Name | MARY ELLEN WEEG AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1850 SILVER CROSS BLVD
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City | NEW LENOX
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State | IL
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Zip | 60451-9508
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Country | US
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Telephone | 815-300-5783
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Fax | 815-485-4830
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Provider Business Mailing Address
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Address Line | 1850 SILVER CROSS BLVD
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City | NEW LENOX
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State | IL
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Zip | 60451-9508
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Country | US
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Telephone | 815-300-5783
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Fax | 815-485-4830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 309.021859
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License Number State | IL
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