Provider Demographics
NPI:1720898117
Name:WEAVER, NAVADA RENEE (RN)
Entity type:Individual
Prefix:PROF
First Name:NAVADA
Middle Name:RENEE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 SOUTHWESTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-2744
Mailing Address - Country:US
Mailing Address - Phone:502-415-6139
Mailing Address - Fax:
Practice Address - Street 1:902 SOUTHWESTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-2744
Practice Address - Country:US
Practice Address - Phone:502-415-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1148409163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse