Provider Demographics
NPI:1164581179
Name:WEAKLEY, MARIE L
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:L
Last Name:WEAKLEY
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 1:242 S TEXAS AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3135
Mailing Address - Country:US
Mailing Address - Phone:956-565-9228
Mailing Address - Fax:956-565-9149
Practice Address - Street 1:242 S TEXAS AVE STE 9
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3135
Practice Address - Country:US
Practice Address - Phone:956-565-9228
Practice Address - Fax:956-565-9149
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92153747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013656Medicaid