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General NPI Number Information
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NPI Number | 1821823956
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Entity Type | Individual
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Provider Name | AUTUMN WEIDENBACH APRN
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Gender | Female
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 5445 LA SIERRA DR STE 105
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City | DALLAS
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State | TX
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Zip | 75231-2352
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Country | US
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Telephone | 214-540-1428
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 PLUMMER DR
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City | ROCKWALL
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State | TX
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Zip | 75087-2321
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Country | US
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Telephone | 972-849-5026
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1170316
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License Number State | TX
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