MEDICARE: MS. THERESA CLARE WEIR MSN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP/RN 242569	MA
2	363LA2200X	Adult Health Nurse Practitioner	NP242569	MA

General Provider Information

NPI Number	:	1699772715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA CLARE WEIR MSN, FNP

Provider Business Mailing Address
First Line	:	720 HARRISON AVE
Second Line	:	DOB 503
City	:	BOSTON
State	:	MA
Zip	:	02118-2118
Country	:	US
Telephone Number	:	617-414-5405
Fax Number	:	617-414-6031

Provider Business Practice Location Address
First Line	:	725 ALBANY STREET
Second Line	:	SHAPIRO 5 AND 6
City	:	BOSTON
State	:	MA
Zip	:	02118-2526
Country	:	US
Telephone Number	:	617-414-5951
Fax Number	:	617-414-9201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/04/2018

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