1437492436 NPI number — MELISA WEAVER APRN - CNP PLLC

Table of content: (NPI 1437492436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437492436 NPI number — MELISA WEAVER APRN - CNP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELISA WEAVER APRN - CNP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1437492436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 RENAISSANCE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-359-3475
Provider Business Mailing Address Fax Number:
405-341-2495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 RENAISSANCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-359-2473
Provider Business Practice Location Address Fax Number:
405-341-2495
Provider Enumeration Date:
03/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
MELISA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OWNER / NURSE PRACTITIONER
Authorized Official Telephone Number:
405-359-3475

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  71855 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com