Provider Demographics
NPI:1427245307
Name:TASKER-WEAVER, SUSAN (MS,APRN,PMH,BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TASKER-WEAVER
Suffix:
Gender:F
Credentials:MS,APRN,PMH,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1817
Mailing Address - Country:US
Mailing Address - Phone:301-777-0633
Mailing Address - Fax:
Practice Address - Street 1:907 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1817
Practice Address - Country:US
Practice Address - Phone:301-777-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063139163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD953LMedicare PIN