Healthcare Provider Details

I. General information

NPI: 1417887365
Provider Name (Legal Business Name): ZENA WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 ASPEN PL
SUN PRAIRIE WI
53590-1171
US

IV. Provider business mailing address

1224 ASPEN PL
SUN PRAIRIE WI
53590-1171
US

V. Phone/Fax

Practice location:
  • Phone: 608-419-3255
  • Fax:
Mailing address:
  • Phone: 608-419-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberWI035580601416
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: