Provider Demographics
NPI:1740275874
Name:WEIR, SUSAN D (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:WEIR
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:PO BOX 16820
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6820
Mailing Address - Country:US
Mailing Address - Phone:281-240-3773
Mailing Address - Fax:281-239-6268
Practice Address - Street 1:2201 W HOLCOMBE BLVD
Practice Address - Street 2:STE 325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2096
Practice Address - Country:US
Practice Address - Phone:713-668-4100
Practice Address - Fax:713-668-4105
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2013-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX733544363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185998501Medicaid
TX8J5718Medicare PIN