Provider Demographics
NPI:1780627315
Name:WEAVER, ANDREW WILSON (FNP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILSON
Last Name:WEAVER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7515
Mailing Address - Country:US
Mailing Address - Phone:910-343-8209
Mailing Address - Fax:910-343-6377
Practice Address - Street 1:7010 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9728
Practice Address - Country:US
Practice Address - Phone:910-686-1099
Practice Address - Fax:910-686-9595
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201330OtherNC MEDICAL LIC. NO.
NC145149OtherNC RN LIC. NO.
NC0350072OtherANCC CERTIFICATION NO.
NCMW0595927OtherDEA NO.
2599369Medicare ID - Type Unspecified
NC145149OtherNC RN LIC. NO.