Provider Demographics
NPI:1164017950
Name:WEAVER, MALIA MARIE
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:MARIE
Last Name:WEAVER
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 1:248 BACHTEL ST SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3139
Mailing Address - Country:US
Mailing Address - Phone:234-425-9450
Mailing Address - Fax:
Practice Address - Street 1:248 BACHTEL ST SE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-3139
Practice Address - Country:US
Practice Address - Phone:234-425-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker