Provider Demographics
NPI:1447979398
Name:WEAVER, PAMELA ELISE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELISE
Last Name:WEAVER
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 1:8710 BRAZKE CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2061
Mailing Address - Country:US
Mailing Address - Phone:240-432-1582
Mailing Address - Fax:
Practice Address - Street 1:1412 TRINIDAD AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2812
Practice Address - Country:US
Practice Address - Phone:202-399-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant