Provider Demographics
NPI:1740767359
Name:WEAVER, SHANNON (CNM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:100 K JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2275
Mailing Address - Country:US
Mailing Address - Phone:609-537-7200
Mailing Address - Fax:609-400-5452
Practice Address - Street 1:433 BELLEVUE AVE FL 3
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4514
Practice Address - Country:US
Practice Address - Phone:609-394-4111
Practice Address - Fax:609-394-4070
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010661176B00000X
NJ25ME00064601176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife