Healthcare Provider Details

I. General information

NPI: 1144535279
Provider Name (Legal Business Name): ASHLEE FAYE WEAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 04/06/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 W MAIN ST SUITE 100
LEOLA PA
17540-1761
US

IV. Provider business mailing address

3421 CONCORD RD SUITE 100
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-6122
  • Fax: 717-656-0142
Mailing address:
  • Phone: 717-656-6122
  • Fax: 717-656-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA002508
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054462
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: