Provider Demographics
NPI:1114393840
Name:WEAVER, ANTHONY CURTISS (LPN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CURTISS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3338
Mailing Address - Country:US
Mailing Address - Phone:716-948-7743
Mailing Address - Fax:
Practice Address - Street 1:59 GERALD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3338
Practice Address - Country:US
Practice Address - Phone:716-948-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322810164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse