Provider Demographics
NPI:1851065825
Name:WEAVER, CARRIE E (APRN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:E
Last Name:WEAVER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 BURT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1500
Mailing Address - Country:US
Mailing Address - Phone:024-302-2775
Mailing Address - Fax:833-471-4570
Practice Address - Street 1:11717 BURT ST STE 203
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1500
Practice Address - Country:US
Practice Address - Phone:402-302-2775
Practice Address - Fax:833-471-4570
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113828363LP0808X
IAG168303363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health