Provider Demographics
NPI:1578886008
Name:WEEKS, DALE KATHLEEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:KATHLEEN
Last Name:WEEKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:WEEKS
Other - Last Name:DAVENPORT/HOWD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3020 FORD RD
Mailing Address - Street 2:
Mailing Address - City:VENICE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13147-4146
Mailing Address - Country:US
Mailing Address - Phone:315-364-7261
Mailing Address - Fax:
Practice Address - Street 1:3020 FORD ROAD
Practice Address - Street 2:
Practice Address - City:VENICE CENTER
Practice Address - State:NY
Practice Address - Zip Code:13147-4146
Practice Address - Country:US
Practice Address - Phone:315-364-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212810-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse