Provider Demographics
NPI:1952999369
Name:WEAVER, SUSAN N/A
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:N/A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 N LEUTZ RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9713
Mailing Address - Country:US
Mailing Address - Phone:419-262-1419
Mailing Address - Fax:
Practice Address - Street 1:1126 JAMES GATE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7819
Practice Address - Country:US
Practice Address - Phone:419-262-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker