Provider Demographics
NPI:1093585846
Name:WEAVER, ERICA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 WAKEFIELD PINES DR STE 108A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8299
Mailing Address - Country:US
Mailing Address - Phone:862-755-5580
Mailing Address - Fax:
Practice Address - Street 1:2940 WAKEFIELD PINES DR STE 108A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8299
Practice Address - Country:US
Practice Address - Phone:862-755-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management