Provider Demographics
NPI:1396962163
Name:WEAVER, PATRICIA MARY (NNP, BSN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NNP, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 S CATHAY ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2302
Mailing Address - Country:US
Mailing Address - Phone:303-690-0486
Mailing Address - Fax:303-690-0486
Practice Address - Street 1:1501 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5411
Practice Address - Country:US
Practice Address - Phone:303-695-2673
Practice Address - Fax:303-695-2626
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60871363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60871OtherNURSING LICENSE