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General NPI Number Information
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NPI Number | 1538050612
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Entity Type | Individual
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Provider Name | MIKAYLA ROSE WEAVER PHDHP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 471 HEPBURN ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-6122
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Country | US
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Telephone | 570-567-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 441 MAIN ST
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City | SALLADASBURG
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State | PA
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Zip | 17740-7409
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Country | US
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Telephone | 814-221-3592
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH075247
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License Number State | PA
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