Provider Demographics
NPI:1538665757
Name:WEGER, ASHLEY MARYANN MAE (LVN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARYANN MAE
Last Name:WEGER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 PEARSON RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74733-3229
Mailing Address - Country:US
Mailing Address - Phone:580-920-5241
Mailing Address - Fax:
Practice Address - Street 1:1159 PEARSON RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:OK
Practice Address - Zip Code:74733-3229
Practice Address - Country:US
Practice Address - Phone:580-920-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK339219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNON