Provider Demographics
NPI:1164836649
Name:WEAVER, JANET (RN)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2610
Mailing Address - Country:US
Mailing Address - Phone:937-208-2004
Mailing Address - Fax:937-208-8828
Practice Address - Street 1:725 S LUDLOW ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2610
Practice Address - Country:US
Practice Address - Phone:937-208-2004
Practice Address - Fax:937-208-8828
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167568163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse