Provider Demographics
NPI:1548725559
Name:WEBER-PARKER, MALIA
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:WEBER-PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:
Other - Last Name:SAMUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP, PMHNP
Mailing Address - Street 1:75409 FOX CROSS AVE
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0155
Mailing Address - Country:US
Mailing Address - Phone:413-205-7405
Mailing Address - Fax:
Practice Address - Street 1:771 BOSTON POST RD E STE 11
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3759
Practice Address - Country:US
Practice Address - Phone:508-593-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily