MEDICARE: AMANDA MICHELLE WEAVER CRNP

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
1	363LF0000X	Family Nurse Practitioner	F07202348	AL

General Provider Information

NPI Number	:	1689267338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MICHELLE WEAVER CRNP

Provider Business Mailing Address
First Line	:	3389 BERKLEY HILLS DR E
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-8026
Country	:	US
Telephone Number	:	256-490-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3389 BERKLEY HILLS DR E
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-8026
Country	:	US
Telephone Number	:	256-490-9900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2021
Last Update Date	:	02/13/2021

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Directions to “ AMANDA MICHELLE WEAVER CRNP” Practice Location

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