Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP015404 | PA |
NPI | 1023483047 |
---|---|
Provider Name | Jennifer Anne Weaver |
First Address | Lebanon, PA 17046-4871 |
Second Address | Lebanon, PA 17046-4871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2015 |
Last Update Date | 02/12/2015 |