Provider Demographics
NPI:1073233847
Name:WECKER, MARK A
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 ANDOVER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3128
Mailing Address - Country:US
Mailing Address - Phone:310-409-7744
Mailing Address - Fax:
Practice Address - Street 1:278 ANDOVER RIDGE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3128
Practice Address - Country:US
Practice Address - Phone:310-409-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program