Provider Demographics
NPI:1790989218
Name:WEAVER, JONATHAN P (CRNA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:WEAVER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6738
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-0738
Mailing Address - Country:US
Mailing Address - Phone:610-988-6060
Mailing Address - Fax:
Practice Address - Street 1:1 GRANITE POINT DR STE 200
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1992
Practice Address - Country:US
Practice Address - Phone:610-685-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA78052367500000X
PA078052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108434OtherGEISINGER
PA11803086OtherCAQH
PA1027812500001Medicaid
PA1580156OtherGATEWAY
PA1982255OtherHIGHMARK
PA1982255OtherFIRST PRIORITY
PA2858756000OtherIBC
PA50069828OtherCAPITAL ADVANTAGE
PA9317982OtherAETNA
PA1982255OtherHIGHMARK
PA2858756000OtherIBC