Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R731838 | MS |
N | 363LA2200X | Nurse Practitioner - Adult Health | R731838 | MS |
NPI | 1013999838 |
---|---|
Provider Name | Patti Suzanne Weaver |
First Address | Meridian, MS 39301-4158 |
Second Address | Meridian, MS 39301-4158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 08/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00124944 | (05) | MS |
500024670 | RAILROAD MEDICARE (01) | |
891003790 | (05) | AL |
P37491 | (02) |