Provider Demographics
NPI:1124041876
Name:WEATHERS, MARY E (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:CRNA
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 6050
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-6050
Mailing Address - Country:US
Mailing Address - Phone:956-541-1278
Mailing Address - Fax:956-541-2854
Practice Address - Street 1:1072 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9988
Practice Address - Country:US
Practice Address - Phone:956-541-1278
Practice Address - Fax:956-541-2854
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518535367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120056007Medicaid
TX120056007Medicaid
TXR93612Medicare UPIN