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General NPI Number Information
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NPI Number | 1306037197
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Entity Type | Individual
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Provider Name | DIANNE MARIE WEAVER D.O.M.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 1919 5TH ST SUITE N
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City | SANTA FE
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State | NM
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Zip | 87505-5402
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Country | US
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Telephone | 505-699-6468
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Fax |
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Provider Business Mailing Address
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Address Line | 996 CALLE KATARINA
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City | SANTA FE
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State | NM
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Zip | 87507-5008
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Country | US
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Telephone | 505-424-3087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 884
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License Number State | NM
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