Provider Demographics
NPI:1790359701
Name:WEAVER, JENNIFER R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:OH
Mailing Address - Zip Code:45349
Mailing Address - Country:US
Mailing Address - Phone:937-926-1344
Mailing Address - Fax:
Practice Address - Street 1:275 W CLARK ST
Practice Address - Street 2:
Practice Address - City:NORTH HAMPTON
Practice Address - State:OH
Practice Address - Zip Code:45349
Practice Address - Country:US
Practice Address - Phone:937-926-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP0028923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily