Provider Demographics
NPI:1225543697
Name:WEAVER, VICTORIA L (CRNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 WILLOW STREET PIKE N STE A
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9231
Mailing Address - Country:US
Mailing Address - Phone:717-464-9430
Mailing Address - Fax:717-464-1680
Practice Address - Street 1:2850 WILLOW STREET PIKE N STE A
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9231
Practice Address - Country:US
Practice Address - Phone:717-464-9430
Practice Address - Fax:717-464-1680
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily