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NPI Code Detail

MEDICARE: NICOLE WEAVER

MEDICARE: NICOLE 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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689505612
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE WEAVER
Provider Business Mailing Address
First Line : 428 N SARWIL DR
Second Line :
City : CANAL WINCHESTER
State : OH
Zip : 43110-2002
Country : US
Telephone Number : 614-312-6696
Fax Number :
Provider Business Practice Location Address
First Line : 10400 BLACKLICK EASTERN RD
Second Line :
City : PICKERINGTON
State : OH
Zip : 43147-8235
Country : US
Telephone Number : 614-726-7359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ NICOLE WEAVER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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