Provider Demographics
NPI:1407276843
Name:WEATHERS, ALFIE MARIE (STNA)
Entity Type:Individual
Prefix:
First Name:ALFIE
Middle Name:MARIE
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:ALFIE
Other - Middle Name:MARIE
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STNA
Mailing Address - Street 1:569 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2867
Mailing Address - Country:US
Mailing Address - Phone:614-212-0843
Mailing Address - Fax:
Practice Address - Street 1:569 STEWART AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2867
Practice Address - Country:US
Practice Address - Phone:614-212-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32004720795376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide