Provider Demographics
NPI:1811319783
Name:WEAVER, DANIELLE YVONNE (APRN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:YVONNE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 POINTER TRL W
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2236
Mailing Address - Country:US
Mailing Address - Phone:479-922-2222
Mailing Address - Fax:479-922-2227
Practice Address - Street 1:109 POINTER TRL W
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2236
Practice Address - Country:US
Practice Address - Phone:479-922-2222
Practice Address - Fax:479-922-2227
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004559363LF0000X
OK102073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily