Provider Demographics
NPI:1174081848
Name:WEATHERBEE, ELISA JULIETT (CM, SA-C)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:JULIETT
Last Name:WEATHERBEE
Suffix:
Gender:F
Credentials:CM, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4325
Mailing Address - Country:US
Mailing Address - Phone:609-588-9225
Mailing Address - Fax:
Practice Address - Street 1:45 COLLINS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-4325
Practice Address - Country:US
Practice Address - Phone:609-588-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001936-01176B00000X
WI15-706246ZC0007X
NJ25MM000002900176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant