Provider Demographics
NPI:1164028817
Name:WEAVER, GEORGE WALTER (CRNP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WALTER
Last Name:WEAVER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BRYAN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2413
Mailing Address - Country:US
Mailing Address - Phone:814-643-6300
Mailing Address - Fax:814-643-8776
Practice Address - Street 1:900 BRYAN ST STE 5
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2413
Practice Address - Country:US
Practice Address - Phone:814-643-6300
Practice Address - Fax:814-643-8776
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022887363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health