Provider Demographics
NPI:1336576776
Name:WEAVER, CHARLENE SHANDELL (FNP-C)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:SHANDELL
Last Name:WEAVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4638
Practice Address - Country:US
Practice Address - Phone:980-330-6898
Practice Address - Fax:980-330-6899
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006448363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3923Medicaid
NC1336576776Medicaid
NCNCG501CMedicare PIN
NCNCG501FMedicare PIN
NCNCG501BMedicare PIN
NCNCG501DMedicare PIN
SCNP3923Medicaid