Provider Demographics
NPI:1598986945
Name:WEIR, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WEIR
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 1:1831 BRECK AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5002
Mailing Address - Country:US
Mailing Address - Phone:307-251-3262
Mailing Address - Fax:
Practice Address - Street 1:1831 BRECK AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5002
Practice Address - Country:US
Practice Address - Phone:307-251-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY385H00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered385H00000XRespite Care FacilityRespite Care
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services