Healthcare Provider Details

I. General information

NPI: 1093702102
Provider Name (Legal Business Name): CHRISTINE A. WEAVER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415A BURKARTH RD
WARRENSBURG MO
64093-3101
US

IV. Provider business mailing address

PO BOX 513
WARRENSBURG MO
64093-0513
US

V. Phone/Fax

Practice location:
  • Phone: 660-429-2228
  • Fax: 660-429-2992
Mailing address:
  • Phone: 660-429-2228
  • Fax: 660-429-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number109665
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: