Provider Demographics
NPI:1508206665
Name:WEAVER, LAURE RENAE (NP)
Entity Type:Individual
Prefix:
First Name:LAURE
Middle Name:RENAE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8833
Mailing Address - Fax:607-729-5899
Practice Address - Street 1:4417 VESTAL PKWY E
Practice Address - Street 2:UHS CARDIOLOGY
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-729-8833
Practice Address - Fax:607-729-5899
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily