MEDICARE: SARAH ELIZABETH WEAVER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN68389	ME

General Provider Information

NPI Number	:	1922703412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH WEAVER RN

Provider Business Mailing Address
First Line	:	33 SALT POND RD
Second Line	:
City	:	FRIENDSHIP
State	:	ME
Zip	:	04547-4101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 SALT POND RD
Second Line	:
City	:	FRIENDSHIP
State	:	ME
Zip	:	04547-4101
Country	:	US
Telephone Number	:	207-691-9484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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