Provider Demographics
NPI:1891283453
Name:WESTON, MARIA ELIZABETH (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELIZABETH
Last Name:WESTON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3959
Mailing Address - Country:US
Mailing Address - Phone:248-296-3765
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD STE 248
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-1515
Practice Address - Fax:248-551-1516
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303808363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner