Provider Demographics
NPI:1285154716
Name:WEAVER, MELISSA HINSON
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:HINSON
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 NAHUNTA RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-8638
Mailing Address - Country:US
Mailing Address - Phone:919-738-8239
Mailing Address - Fax:
Practice Address - Street 1:321 BUCK SWAMP RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8030
Practice Address - Country:US
Practice Address - Phone:919-330-4277
Practice Address - Fax:919-429-6001
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH-096-048310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility