Healthcare Provider Details

I. General information

NPI: 1093784514
Provider Name (Legal Business Name): AUDREY LISA WEAVER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: A LISA SNYDER CRNP

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S GEORGE ST STE 200
YORK PA
17401-3160
US

IV. Provider business mailing address

1803 MOUNT ROSE AVE STE B3
YORK PA
17403-3026
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2334
  • Fax: 717-851-3498
Mailing address:
  • Phone: 717-851-6816
  • Fax: 717-851-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP006990B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: