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General NPI Number Information
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NPI Number | 1972937795
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Entity Type | Individual
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Provider Name | ANDY MICHAEL WEATHERS R.T(R), CV
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Gender | Male
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 1054 VINYARD DR
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City | OREGON
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State | WI
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Zip | 53575-3314
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Country | US
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Telephone | 608-250-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 1054 VINYARD DR
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City | OREGON
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State | WI
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Zip | 53575-3314
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Country | US
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Telephone | 608-250-0550
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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 | 2471C1101X
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Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
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License Number | 319217
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License Number State | MN
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