Basic Information
| Provider Information | |||||||||
| NPI: | 1831514389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNET | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | WEILAND | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSN, RN, CPNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WEILAND | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | A. | ||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1533 ARTHUR AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441073803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162286663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2500 METROHEALTH DR. | ||||||||
| Address2: | DEPARTMENT OF PEDIATRICS | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167787800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2014 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN279694-COA1 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.