Healthcare Provider Details

I. General information

NPI: 1063408953
Provider Name (Legal Business Name): MARGARET E WEIR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET DUNLEAVY

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NORTH ST
BRISTOL CT
06010-4190
US

IV. Provider business mailing address

PO BOX 2828
BRISTOL CT
06011-2828
US

V. Phone/Fax

Practice location:
  • Phone: 860-314-2082
  • Fax: 860-314-8133
Mailing address:
  • Phone: 860-585-3906
  • Fax: 860-585-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001802
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: