Provider Demographics
NPI:1427543503
Name:WEAVER, TRINA
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
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 1:109 KATY DR
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:TX
Mailing Address - Zip Code:75440-2227
Mailing Address - Country:US
Mailing Address - Phone:817-823-9159
Mailing Address - Fax:
Practice Address - Street 1:109 KATY DR
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440-2227
Practice Address - Country:US
Practice Address - Phone:817-823-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338946164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse