Provider Demographics
NPI:1215293899
Name:WEAVER, SHARON KAY (RN, MRT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RN, MRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6656
Mailing Address - Country:US
Mailing Address - Phone:575-430-1557
Mailing Address - Fax:575-434-2413
Practice Address - Street 1:1200 N WHITE SANDS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6774
Practice Address - Country:US
Practice Address - Phone:575-430-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist