Provider Demographics
NPI:1174828800
Name:WEAVER, FAZIA (NP)
Entity Type:Individual
Prefix:
First Name:FAZIA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FAZIA
Other - Middle Name:
Other - Last Name:SENDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:300 POMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2103
Mailing Address - Country:US
Mailing Address - Phone:973-720-5000
Mailing Address - Fax:
Practice Address - Street 1:300 POMPTON RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2103
Practice Address - Country:US
Practice Address - Phone:973-720-2956
Practice Address - Fax:973-720-2632
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00313200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health