Provider Demographics
NPI:1417087677
Name:WEAVER, PAMELA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 MCMECHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9466
Mailing Address - Country:US
Mailing Address - Phone:937-459-7632
Mailing Address - Fax:
Practice Address - Street 1:8614 MCMECHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-9466
Practice Address - Country:US
Practice Address - Phone:937-459-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2433638Medicaid