MEDICARE: LESETTA 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	363LA2200X	Adult Health Nurse Practitioner	SP008057	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00165180	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1550135	OTHER	PA	GATEWAY
3	NON HMO# 7424770	OTHER	PA	AETNA
4	001933875	OTHER	PA	HIGHMARK BLUE SHIELD
5	50056000	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1750346763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESETTA WEAVER CRNP

Provider Business Mailing Address
First Line	:	540N DUKE ST 244
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2374
Country	:	US
Telephone Number	:	717-826-9781
Fax Number	:	717-945-5177

Provider Business Practice Location Address
First Line	:	540N DUKE ST 244
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2374
Country	:	US
Telephone Number	:	717-826-9781
Fax Number	:	717-945-5177

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	03/15/2024

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Directions to “ LESETTA WEAVER CRNP” Practice Location

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