Healthcare Provider Details

I. General information

NPI: 1366454720
Provider Name (Legal Business Name): SANDRA L WEAVER RN, LCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NEWMAN AVE
HARRISONBURG VA
22801-4004
US

IV. Provider business mailing address

110 NEWMAN AVENUE
HARRISONBURG VA
22801
US

V. Phone/Fax

Practice location:
  • Phone: 540-434-2800
  • Fax: 540-434-2883
Mailing address:
  • Phone: 540-434-2800
  • Fax: 540-434-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001092919
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000490
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: