MEDICARE: MS. CAROLE JEAN WEAVER R.N.

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	163WH0200X	Home Health Registered Nurse	R.N. 128424	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1922128990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLE JEAN WEAVER R.N.

Provider Business Mailing Address
First Line	:	1695 QUIGLEY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-3433
Country	:	US
Telephone Number	:	614-237-5474
Fax Number	:	614-237-5474

Provider Business Practice Location Address
First Line	:	2556 SONATA DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-3211
Country	:	US
Telephone Number	:	614-237-9476
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/09/2007

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