Provider Demographics
NPI:1518034784
Name:WEAVER, MARILYN MARGARITA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MARGARITA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 MARSTON LANE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1334
Mailing Address - Country:US
Mailing Address - Phone:708-798-2322
Mailing Address - Fax:
Practice Address - Street 1:2126 MARSTON LN
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1334
Practice Address - Country:US
Practice Address - Phone:708-798-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-211924163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult