Provider Demographics
NPI:1437492436
Name:MELISA WEAVER APRN - CNP PLLC
Entity Type:Organization
Organization Name:MELISA WEAVER APRN - CNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:405-359-3475
Mailing Address - Street 1:1800 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3023
Mailing Address - Country:US
Mailing Address - Phone:405-359-3475
Mailing Address - Fax:405-341-2495
Practice Address - Street 1:1800 RENAISSANCE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-359-2473
Practice Address - Fax:405-341-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71855363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty