Provider Demographics
NPI:1922128990
Name:WEAVER, CAROLE JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:JEAN
Last Name: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 1:1695 QUIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3433
Mailing Address - Country:US
Mailing Address - Phone:614-237-5474
Mailing Address - Fax:614-237-5474
Practice Address - Street 1:2556 SONATA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3211
Practice Address - Country:US
Practice Address - Phone:614-237-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR.N. 128424163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2109006Medicaid