Provider Demographics
NPI:1346819067
Name:ALLEN MAEWEATHER, TANEISHA RENIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TANEISHA
Middle Name:RENIA
Last Name:ALLEN MAEWEATHER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7558 BANKS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-1673
Mailing Address - Country:US
Mailing Address - Phone:708-980-4994
Mailing Address - Fax:
Practice Address - Street 1:7558 BANKS ST APT 2
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1673
Practice Address - Country:US
Practice Address - Phone:708-980-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041467123163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical