Healthcare Provider Details

I. General information

NPI: 1831897313
Provider Name (Legal Business Name): HAYLEY ELIZABETH WEAVER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E BROAD ST STE 100
COLUMBUS OH
43215-3989
US

IV. Provider business mailing address

2780 AIRPORT DR STE 100
COLUMBUS OH
43219-2289
US

V. Phone/Fax

Practice location:
  • Phone: 614-859-1850
  • Fax: 614-753-4079
Mailing address:
  • Phone: 614-859-1906
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.10013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: