Provider Demographics
NPI:1831849579
Name:WEAVER, BRENDA A (APN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:A
Other - Last Name:CHAPLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3225 HEDLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6248
Mailing Address - Country:US
Mailing Address - Phone:217-726-7300
Mailing Address - Fax:
Practice Address - Street 1:3225 HEDLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6248
Practice Address - Country:US
Practice Address - Phone:217-726-7300
Practice Address - Fax:217-726-5989
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041430460163W00000X
IL209025209363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041430460OtherRN