Provider Demographics
NPI:1750850665
Name:WEATHERS, FAITHE (CNP)
Entity Type:Individual
Prefix:
First Name:FAITHE
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-2366
Mailing Address - Country:US
Mailing Address - Phone:508-675-1522
Mailing Address - Fax:508-676-5647
Practice Address - Street 1:528 NEWTON ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2366
Practice Address - Country:US
Practice Address - Phone:508-675-1522
Practice Address - Fax:508-676-5647
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN1861363L00000X
MARN2264586363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner