Provider Demographics
NPI:1427755628
Name:WEAVER, STACIE DAWN
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:DAWN
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 1:510 RENICK AVE LOT 2
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2075
Mailing Address - Country:US
Mailing Address - Phone:740-630-4675
Mailing Address - Fax:
Practice Address - Street 1:510 RENICK AVE LOT 2
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2075
Practice Address - Country:US
Practice Address - Phone:740-630-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health