Provider Demographics
NPI:1932352853
Name:WEAVER, CARLA COATS (APRN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:COATS
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 MARIO CAPECCHI DR
Mailing Address - Street 2:4TH FLOOR BURN CLINIC
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-851-3050
Mailing Address - Fax:801-581-8446
Practice Address - Street 1:50 MARIO CAPECCHI DR
Practice Address - Street 2:4TH FLOOR BURN CLINIC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-851-3050
Practice Address - Fax:801-581-8446
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5039064-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner