Provider Demographics
NPI:1043815780
Name:WEIS, CHRISTINE LEE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:WEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0492
Mailing Address - Country:US
Mailing Address - Phone:304-692-4889
Mailing Address - Fax:304-864-5261
Practice Address - Street 1:265 X ROAD
Practice Address - Street 2:
Practice Address - City:ARTHURDALE
Practice Address - State:WV
Practice Address - Zip Code:26520
Practice Address - Country:US
Practice Address - Phone:304-692-4889
Practice Address - Fax:304-864-7353
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant