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NPI Code Detail

MEDICARE: ALEXANDRIA GABRIELLE WEAVER

MEDICARE: ALEXANDRIA GABRIELLE 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
1251B00000XCase Management Agency
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1285368415
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRIA GABRIELLE WEAVER
Provider Business Mailing Address
First Line : 118 W KEETOOWAH ST
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-3820
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 118 W KEETOOWAH ST
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-3820
Country : US
Telephone Number : 918-708-2015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2022
Last Update Date : 07/25/2022

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Directions to “ ALEXANDRIA GABRIELLE WEAVER ” Practice Location

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