Provider Demographics
NPI:1265797492
Name:WEAVER, MARTHA DUNAWAY (CNM, RN)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:DUNAWAY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
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Mailing Address - Street 1:8415 CLAY DR
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5518
Mailing Address - Country:US
Mailing Address - Phone:301-839-2149
Mailing Address - Fax:301-839-2149
Practice Address - Street 1:1501 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2716
Practice Address - Country:US
Practice Address - Phone:703-549-5070
Practice Address - Fax:703-549-4821
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024095985367A00000X
MDR088638367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife