Provider Demographics
NPI:1740261247
Name:WEAVER, MARY BAKER (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BAKER
Last Name:WEAVER
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 1075 STEPHENSON AVE FT. MONMOUTH
Mailing Address - Street 2:
Mailing Address - City:FT. MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07703
Mailing Address - Country:US
Mailing Address - Phone:732-532-1352
Mailing Address - Fax:
Practice Address - Street 1:6455 MACHINE ST BLDG 2501
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5213
Practice Address - Country:US
Practice Address - Phone:410-278-7670
Practice Address - Fax:877-811-2184
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN045292164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse