Provider Demographics
NPI:1598715104
Name:WEAVER, GAIL (NP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3211 SHANNON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6322
Mailing Address - Country:US
Mailing Address - Phone:800-291-4020
Mailing Address - Fax:919-419-7247
Practice Address - Street 1:316 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2187
Practice Address - Country:US
Practice Address - Phone:800-291-4020
Practice Address - Fax:919-419-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN117742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S84542Medicare UPIN