Provider Demographics
NPI:1366480568
Name:WEITFLE, MARIA T (CNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:WEITFLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5184 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9842
Mailing Address - Country:US
Mailing Address - Phone:513-770-0953
Mailing Address - Fax:513-770-5811
Practice Address - Street 1:5184 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9842
Practice Address - Country:US
Practice Address - Phone:513-770-0953
Practice Address - Fax:513-770-5811
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.0377-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00339266OtherRR MEDICARE
P01347544OtherRR MEDICARE
OH2161986Medicaid
OH2161986Medicaid
NP04139Medicare PIN
P01347544OtherRR MEDICARE
OHS87438Medicare UPIN
KYWENP04136Medicare UPIN