Most Relevant Information
Provider Data
| NPI Number: | 1003481904 |
| Provider Name: | ILENE WEESE |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/24/2021 |
| Last Updated: | 05/24/2021 |
Provider Practice Location
1408 HARRISON AVE
ELKINS
WV
262413325
Practice Location Phone/Fax
| Phone: | 3046364390 |
| Fax: |
Provider Mailing Location
12 ROSETTA RD
PETERSBURG
WV
268478630
Provider Mailing Phone/Fax
| Phone: | 3042571772 |
| Fax: |