Healthcare Provider Details

I. General information

NPI: 1740275874
Provider Name (Legal Business Name): SUSAN D WEIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 W HOLCOMBE BLVD STE 325
HOUSTON TX
77030-2096
US

IV. Provider business mailing address

PO BOX 16820
SUGAR LAND TX
77496-6820
US

V. Phone/Fax

Practice location:
  • Phone: 713-668-4100
  • Fax: 713-668-4105
Mailing address:
  • Phone: 281-240-3773
  • Fax: 281-239-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number733544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: