Provider Demographics
NPI:1215475108
Name:WEAVER, PATRICIA ANN (RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3089 LEE ST SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4420
Mailing Address - Country:US
Mailing Address - Phone:770-801-0321
Mailing Address - Fax:770-801-0321
Practice Address - Street 1:3089 LEE ST SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4420
Practice Address - Country:US
Practice Address - Phone:770-801-0321
Practice Address - Fax:770-801-0321
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213590163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health