Provider Demographics
NPI:1841390366
Name:WEAVER, LESLEY S (CRNA)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:S
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 NW NORTH RIDGE DR STE B
Mailing Address - Street 2:ANESTHESIA SERVICES OF BLUE SPRINGS
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6320
Mailing Address - Country:US
Mailing Address - Phone:816-988-8415
Mailing Address - Fax:816-988-8395
Practice Address - Street 1:1209 NW NORTH RIDGE DR STE B
Practice Address - Street 2:ANESTHESIA SERVICES OF BLUE SPRINGS
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6320
Practice Address - Country:US
Practice Address - Phone:816-988-8415
Practice Address - Fax:816-988-8395
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO048202367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO919743310Medicaid
MOP00211611Medicare PIN
MOP00295298Medicare PIN
MOS55B442Medicare PIN
MO919743310Medicaid