Provider Demographics
NPI:1093784514
Name:WEAVER, AUDREY LISA (CRNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LISA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:A
Other - Middle Name:LISA
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:STE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-6816
Mailing Address - Fax:717-851-6892
Practice Address - Street 1:605 S GEORGE ST
Practice Address - Street 2:STE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-3160
Practice Address - Country:US
Practice Address - Phone:717-851-2334
Practice Address - Fax:717-851-3498
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006990B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP64691OtherHEALTH ASSURANCE
PA500027775OtherRAILROAD MEDICARE
PA2688767OtherHIGHMARK BLUE SHIELD
PA1550633OtherGATEWAY MEDICARE ASSURED
PA50000329OtherCAPITAL BLUE CROSS
PA50000329OtherCAPITAL BLUE CROSS
PA2688767OtherHIGHMARK BLUE SHIELD
PAP64691OtherHEALTH ASSURANCE