Provider Demographics
NPI:1477103687
Name:WEAVER, JOANNA ELIZABETH (LVN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:ELIZABETH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6328 OPAL HILL CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1588
Mailing Address - Country:US
Mailing Address - Phone:469-939-6949
Mailing Address - Fax:
Practice Address - Street 1:6328 OPAL HILL CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1588
Practice Address - Country:US
Practice Address - Phone:469-939-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350392164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse