Basic Information
| Provider Information | |||||||||
| NPI: | 1497056113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEDBERG SIVAM | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN, MSN, ACNS-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WEDBERG | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
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| OtherCredential: | RN, MSN, ACNS-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 N IH 35 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248300 | ||||||||
| FaxNumber: | 5123248301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 N IH 35 STE 300 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123243540 | ||||||||
| FaxNumber: | 5123243541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 364SA2200X | 747238 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.