Provider Demographics
NPI:1598916546
Name:WEAVER, CYNTHIA SUE (RN, APN-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 SE 91 AVE.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-635-4148
Mailing Address - Fax:503-699-7382
Practice Address - Street 1:9300 SE 91 AVE.
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-635-4148
Practice Address - Fax:503-699-7382
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950034NP363L00000X
IL209.007285363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health