Provider Demographics
NPI:1366419806
Name:WEAVER, NANCY A (NP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 EAST ELM STREET
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3131
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:518 E ELM ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-1308
Practice Address - Fax:989-584-0307
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION19780Medicare ID - Type Unspecified
P25835Medicare UPIN