Provider Demographics
NPI:1508909920
Name:WEIMER, MARY BETH (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:WEIMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:13195 METRO PKWY
Practice Address - Street 2:#6-9
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4810
Practice Address - Country:US
Practice Address - Phone:239-344-2348
Practice Address - Fax:239-479-5194
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9406331176B00000X
NJ25ME00022201176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016809500Medicaid
FLIN430ZMedicare PIN