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General NPI Number Information
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NPI Number | 1922204551
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Entity Type | Individual
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Provider Name | MELODY ANN WEAVER PHD FNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 921 S 8TH AVE STOP 8101
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City | POCATELLO
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State | ID
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Zip | 83209
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Country | US
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Telephone | 208-282-5994
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Fax | 208-282-4476
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Provider Business Mailing Address
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Address Line | 921 S 8TH AVE STOP 8101
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City | POCATELLO
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State | ID
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Zip | 83209-0001
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Country | US
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Telephone | 208-282-5994
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Fax | 208-282-4476
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP10764
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License Number State | CA
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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 | 55023
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License Number State | ID
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