Healthcare Provider Details

I. General information

NPI: 1679985170
Provider Name (Legal Business Name): KIRA WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 NE COUCH ST
PORTLAND OR
97232-2922
US

IV. Provider business mailing address

1765 SW TAMARACK ST APT #9
MCMINNVILLE OR
97128-7416
US

V. Phone/Fax

Practice location:
  • Phone: 503-542-4603
  • Fax: 503-233-6093
Mailing address:
  • Phone: 510-384-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: