Basic Information
| Provider Information | |||||||||
| NPI: | 1154576551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEILBAKER | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MATVYA | ||||||||
| OtherFirstName: | ROBYN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 855 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603024420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083861000 | ||||||||
| FaxNumber: | 7083862394 | ||||||||
| Practice Location | |||||||||
| Address1: | 3124 E STATE BLVD | ||||||||
| Address2: | SUITE 6A | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468054798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604715114 | ||||||||
| FaxNumber: | 2604715507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2008 | ||||||||
| LastUpdateDate: | 11/26/2008 | ||||||||
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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 | 363L00000X | 71002810A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163WN0300X | 28151253A | IN | N | Nursing Service Providers | Registered Nurse | Nephrology |
No ID Information.