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General NPI Number Information
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NPI Number | 1356646087
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Entity Type | Individual
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Provider Name | ROBERTA CHRISTINE WEAVER FNP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 1318 BROADWAY
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City | LUBBOCK
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State | TX
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Zip | 79401-3206
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Country | US
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Telephone | 806-765-2611
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Fax | 806-765-6271
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Provider Business Mailing Address
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Address Line | 1313 BROADWAY STE 5
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City | LUBBOCK
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State | TX
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Zip | 79401-3209
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Country | US
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Telephone | 806-765-2611
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Fax | 806-687-5957
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 648686
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP119780
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License Number State | TX
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