| Doctor Name: | SEAN WEAVER |
| NPI Number: | 1619270956 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, NPC |
| License Number: | 2010036624 |
| Business Practice Address: | 211 S 3rd St Louisiana, MO - 633532000 |
| Business Phone Number: | 5737545555 |
| Business Fax Number: | 5737544077 |
| Mailing Address: | 211 S 3rd St, LOUISIANA |
| State: | MO |
| Postal Code: | 633532000 |
| Phone Number: | 5737545555 |
| Fax Number: | 5737544077 |
| NPI Enumeration Date: | 12/08/2010 |
| NPI Last Update Date: | 08/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2010036624 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |