Healthcare Provider Details

I. General information

NPI: 1629134978
Provider Name (Legal Business Name): CHRISTOPHER D WEAVER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W FOREST AVE
JACKSON TN
38301-3901
US

IV. Provider business mailing address

810 W FOREST AVE
JACKSON TN
38301-3942
US

V. Phone/Fax

Practice location:
  • Phone: 731-927-7070
  • Fax: 731-927-7075
Mailing address:
  • Phone: 731-668-1853
  • Fax: 731-664-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12442
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: