Provider Demographics
NPI:1760623797
Name:ELLISON-WEAVER, CHERYL (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:ELLISON-WEAVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 ASHSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8021
Mailing Address - Country:US
Mailing Address - Phone:614-920-3380
Mailing Address - Fax:
Practice Address - Street 1:7808 ASHSTONE CT
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8021
Practice Address - Country:US
Practice Address - Phone:614-920-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN243748163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health