Provider Demographics
NPI:1629790704
Name:WEATHERSBY, TREENA M
Entity Type:Individual
Prefix:
First Name:TREENA
Middle Name:M
Last Name:WEATHERSBY
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 1:18 RIVERLANDS DR APT C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-3519
Mailing Address - Country:US
Mailing Address - Phone:757-243-4794
Mailing Address - Fax:757-586-5663
Practice Address - Street 1:18 RIVERLANDS DR APT C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3519
Practice Address - Country:US
Practice Address - Phone:757-243-4794
Practice Address - Fax:757-586-5663
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver