1366454720 NPI number — MRS. SANDRA L WEAVER RN, LCNS

Table of content: MRS. SANDRA L WEAVER RN, LCNS (NPI 1366454720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366454720 NPI number — MRS. SANDRA L WEAVER RN, LCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAVER
Provider First Name:
SANDRA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, LCNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366454720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 NEWMAN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISONBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-434-2800
Provider Business Mailing Address Fax Number:
540-434-2883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 NEWMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISONBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22801-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-434-2800
Provider Business Practice Location Address Fax Number:
540-434-2883
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  0001092919 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: 0015000490 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 404227 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 466967 . This is a "VALUE OPTIONS PROVIDER NO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C05754 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 081165 . This is a "SENTARA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 187883 . This is a "COMPSYCH PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1164637518 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2028408 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005510805 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11527703 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 117820 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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