Provider Demographics
NPI:1750876785
Name:WEIR, DAVID DWAYNE (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DWAYNE
Last Name:WEIR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:DWAYNE
Other - Last Name:ROGERS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:3883 TURTLE CREEK BLVD APT 818
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4499
Mailing Address - Country:US
Mailing Address - Phone:469-261-5800
Mailing Address - Fax:
Practice Address - Street 1:3883 TURTLE CREEK BLVD APT 818
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:469-261-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138602363LF0000X
TX851509163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse