Provider Demographics
NPI:1013208750
Name:WEBER, JENNIFER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 HOUSTON NORTHCUTT BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3487
Mailing Address - Country:US
Mailing Address - Phone:843-388-6334
Mailing Address - Fax:843-388-6545
Practice Address - Street 1:966 HOUSTON NORTHCUTT BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3487
Practice Address - Country:US
Practice Address - Phone:843-388-6334
Practice Address - Fax:843-388-6545
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily