Provider Demographics
NPI:1750993903
Name:ANDERSON, WESTON TUCKER (RN)
Entity type:Individual
Prefix:MR
First Name:WESTON
Middle Name:TUCKER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19060 E ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6846
Mailing Address - Country:US
Mailing Address - Phone:480-200-8320
Mailing Address - Fax:
Practice Address - Street 1:19060 E ARROWHEAD TRL
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6846
Practice Address - Country:US
Practice Address - Phone:480-200-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221754163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221754OtherARIZONA STATE BOARD OF NURSING