Provider Demographics
NPI:1326659467
Name:WEAVER, CRYSTAL N (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:N
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4297 HONEYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1444
Mailing Address - Country:US
Mailing Address - Phone:937-999-9325
Mailing Address - Fax:
Practice Address - Street 1:859 E SOCIAL ROW RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-4709
Practice Address - Country:US
Practice Address - Phone:937-999-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027318363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care