Doctor Name: | BETH A WEAVER |
NPI Number: | 1447248703 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 4704148660 |
Business Practice Address: | 3190 Northridge Drive Hale, MI - 487399276 |
Business Phone Number: | 9897286000 |
Business Fax Number: | 9897286003 |
Mailing Address: | Po Box 279, HALE |
State: | MI |
Postal Code: | 487390279 |
Phone Number: | 9897286000 |
Fax Number: | 9897286003 |
NPI Enumeration Date: | 10/11/2005 |
NPI Last Update Date: | 03/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704148660 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |