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NPI Code Detail

MEDICARE: ABIGAIL JEAN WEAVER

MEDICARE: ABIGAIL JEAN WEAVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianMN

General Provider Information

NPI Number : 1174455794
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL JEAN WEAVER
Provider Business Mailing Address
First Line : 10450 185TH ST W STE 100
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6696
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10450 185TH ST W STE 100
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6696
Country : US
Telephone Number : 612-509-1283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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Directions to “ ABIGAIL JEAN WEAVER ” Practice Location

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