Healthcare Provider Details

I. General information

NPI: 1366356297
Provider Name (Legal Business Name): RIKKI MARIE WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 CONSTELLATION LOOP
BREMERTON WA
98310-3066
US

IV. Provider business mailing address

3840 CONSTELLATION LOOP
BREMERTON WA
98310-3066
US

V. Phone/Fax

Practice location:
  • Phone: 360-461-7164
  • Fax:
Mailing address:
  • Phone: 360-461-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN61460505
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: