1598916546 NPI number — MRS. CYNTHIA SUE WEAVER RN, APN-C

Table of content: MRS. CYNTHIA SUE WEAVER RN, APN-C (NPI 1598916546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598916546 NPI number — MRS. CYNTHIA SUE WEAVER RN, APN-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAVER
Provider First Name:
CYNTHIA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, APN-C
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:
1598916546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 SE 91 AVE.
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-635-4148
Provider Business Mailing Address Fax Number:
503-699-7382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 SE 91 AVE.
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-635-4148
Provider Business Practice Location Address Fax Number:
503-699-7382
Provider Enumeration Date:
10/08/2008

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: 363L00000X , with the licence number:  200950034NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 209.007285 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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