Provider Demographics
NPI:1275192502
Name:WEAVER, MATTHEW M (CNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:WEAVER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 SHAWNEE LN
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-4145
Mailing Address - Country:US
Mailing Address - Phone:740-672-2309
Mailing Address - Fax:740-672-2310
Practice Address - Street 1:457 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4145
Practice Address - Country:US
Practice Address - Phone:740-672-2309
Practice Address - Fax:740-672-2310
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily