Healthcare Provider Details

I. General information

NPI: 1598730632
Provider Name (Legal Business Name): MARYLOU M WEISS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 EXECUTIVE BLVD STE 200
CHESAPEAKE VA
23320-3671
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-3132
  • Fax: 757-312-6212
Mailing address:
  • Phone: 757-842-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024030820
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: