Provider Demographics
NPI:1558967430
Name:WEAKLAND, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WEAKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29742 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5062
Mailing Address - Country:US
Mailing Address - Phone:440-666-3736
Mailing Address - Fax:
Practice Address - Street 1:29742 WELLINGTON DR
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-5062
Practice Address - Country:US
Practice Address - Phone:440-666-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1831554253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care