Provider Demographics
NPI:1457464711
Name:WEATHERSPOON, MAUREEN CONNOR (EFDA)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:CONNOR
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21345 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1710
Mailing Address - Country:US
Mailing Address - Phone:503-642-4922
Mailing Address - Fax:
Practice Address - Street 1:21345 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-1710
Practice Address - Country:US
Practice Address - Phone:503-642-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7712126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant