Healthcare Provider Details

I. General information

NPI: 1699772715
Provider Name (Legal Business Name): THERESA CLARE WEIR MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET SHAPIRO 5 AND 6
BOSTON MA
02118-2526
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118-2118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5951
  • Fax: 617-414-9201
Mailing address:
  • Phone: 617-414-5405
  • Fax: 617-414-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP/RN 242569
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP242569
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: