Provider Demographics
NPI:1447540919
Name:WEEDEN, KARRIN A
Entity type:Individual
Prefix:
First Name:KARRIN
Middle Name:A
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1615
Mailing Address - Country:US
Mailing Address - Phone:845-778-5704
Mailing Address - Fax:
Practice Address - Street 1:16 HARVARD DR
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1615
Practice Address - Country:US
Practice Address - Phone:845-778-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY562808-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse