Provider Demographics
NPI:1891332151
Name:WEAVER, NICOLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CASHELL FOOTBALL CENTER / MS 265
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0265
Mailing Address - Country:US
Mailing Address - Phone:775-784-3507
Mailing Address - Fax:775-784-8077
Practice Address - Street 1:CASHELL FOOTBALL CENTER / MS 265
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0265
Practice Address - Country:US
Practice Address - Phone:775-784-3507
Practice Address - Fax:775-784-8077
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer