Provider Demographics
NPI:1467664557
Name:WEIDMAN-JOHNSON, MARIE E (NP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:E
Last Name:WEIDMAN-JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST # DB1-077
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-4800
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST # DB1-077
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536615363LA2200X, 363LW0102X
TXAP110633363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467664557OtherBLUE CROSS BLUE SHIELD
TX175916902Medicaid
TXTP1-175916901Medicaid
TX175916902Medicaid
TXTP1-175916901Medicaid
TXQ39946Medicare UPIN