Healthcare Provider Details

I. General information

NPI: 1174799605
Provider Name (Legal Business Name): HELEN WEAVER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS ROAD ST JOHNS MERCY MEDICAL CENTER NICU
ST LOUIS MO
63141
US

IV. Provider business mailing address

1218 WASHINGTON AVE
ALTON IL
62002-2864
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6450
  • Fax:
Mailing address:
  • Phone: 618-462-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number095530
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: