1518247154 NPI number — DR. ANN KELLETT WEAVER

Table of content: DR. ANN KELLETT WEAVER (NPI 1518247154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518247154 NPI number — DR. ANN KELLETT WEAVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAVER
Provider First Name:
ANN
Provider Middle Name:
KELLETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLETT
Provider Other First Name:
ANN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518247154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 N UNION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60505-3513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-585-7594
Provider Business Mailing Address Fax Number:
630-585-7620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 N UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60505-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-585-7594
Provider Business Practice Location Address Fax Number:
630-585-7620
Provider Enumeration Date:
08/26/2011

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: 183500000X , with the licence number:  051292910 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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