Provider Demographics
NPI:1518615616
Name:WEAKS, BARBARA ANN (NURSE MANAGER)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:WEAKS
Suffix:
Gender:F
Credentials:NURSE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 SHELDON AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1836
Mailing Address - Country:US
Mailing Address - Phone:443-873-0579
Mailing Address - Fax:410-644-5609
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5213
Practice Address - Country:US
Practice Address - Phone:443-873-0579
Practice Address - Fax:410-644-5609
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP22824164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse