Healthcare Provider Details

I. General information

NPI: 1255121026
Provider Name (Legal Business Name): LAUREN Y WEAVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S MAIN ST
CHATHAM VA
24531-5436
US

IV. Provider business mailing address

30 S MAIN ST
CHATHAM VA
24531-5436
US

V. Phone/Fax

Practice location:
  • Phone: 434-432-4443
  • Fax:
Mailing address:
  • Phone: 434-432-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: