Healthcare Provider Details

I. General information

NPI: 1841592037
Provider Name (Legal Business Name): AMANDA STEVENS WEAVIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LYNN STEVENS MD

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 3RD ST
SOUTH LAKE TAHOE CA
96150-3465
US

IV. Provider business mailing address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

V. Phone/Fax

Practice location:
  • Phone: 530-543-5711
  • Fax: 530-578-3712
Mailing address:
  • Phone: 530-543-5659
  • Fax: 530-541-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA123236
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20265
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: