Provider Demographics
NPI:1366678005
Name:WEAVER, STEPHANIE R (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3425
Mailing Address - Country:US
Mailing Address - Phone:814-392-2934
Mailing Address - Fax:
Practice Address - Street 1:2821 COURT AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3425
Practice Address - Country:US
Practice Address - Phone:814-392-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN281245164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse