Provider Demographics
NPI:1568127751
Name:WEAKS, HEATHER ELIZABETH (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:WEAKS
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
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 52
Mailing Address - Street 2:
Mailing Address - City:MURCHISON
Mailing Address - State:TX
Mailing Address - Zip Code:75778-0052
Mailing Address - Country:US
Mailing Address - Phone:903-681-1247
Mailing Address - Fax:
Practice Address - Street 1:307 CARTER ROAD
Practice Address - Street 2:
Practice Address - City:MALAKOFF
Practice Address - State:TX
Practice Address - Zip Code:75148
Practice Address - Country:US
Practice Address - Phone:903-681-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX831672163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty