Provider Demographics
NPI:1528692647
Name:JANNA WEAVER NUTRITION & WELLNESS
Entity type:Organization
Organization Name:JANNA WEAVER NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:409-464-9800
Mailing Address - Street 1:721 FENCELINE DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1269
Mailing Address - Country:US
Mailing Address - Phone:940-464-9800
Mailing Address - Fax:940-464-9888
Practice Address - Street 1:721 FENCELINE DR
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-1269
Practice Address - Country:US
Practice Address - Phone:940-464-9800
Practice Address - Fax:940-464-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX926966OtherCDR