Provider Demographics
NPI:1922378678
Name:WEED, MAIA B (APRN)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:B
Last Name:WEED
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5620
Mailing Address - Country:US
Mailing Address - Phone:203-869-0451
Mailing Address - Fax:212-918-9394
Practice Address - Street 1:23 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5620
Practice Address - Country:US
Practice Address - Phone:203-869-0451
Practice Address - Fax:212-918-9394
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004906363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT049006OtherCONNECTICARE
CT8520928OtherCIGNA/GW
CT9356860OtherAETNA