Healthcare Provider Details

I. General information

NPI: 1356991004
Provider Name (Legal Business Name): MRS. AMELIA ANN WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 OAK GROVE CH. RD AMELIA ANN WEAVER
ANGIER NC
27501
US

IV. Provider business mailing address

2622 OAK GROVE CH. RD AMELIA ANN WEAVER
ANGIER NC
27501
US

V. Phone/Fax

Practice location:
  • Phone: 919-868-1763
  • Fax: 919-639-4522
Mailing address:
  • Phone: 919-868-1763
  • Fax: 919-639-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: