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General NPI Number Information
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NPI Number | 1740767359
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Entity Type | Individual
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Provider Name | SHANNON WEAVER CNM
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Gender | Female
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 433 BELLEVUE AVE FL 3
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City | TRENTON
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State | NJ
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Zip | 08618-4514
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Country | US
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Telephone | 609-394-4111
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Fax | 609-394-4070
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Provider Business Mailing Address
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Address Line | 100 K JOHNSON BLVD
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2275
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Country | US
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Telephone | 609-537-7200
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Fax | 609-400-5452
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | MW010661
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 25ME00064601
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License Number State | NJ
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