Individual
KATANYA WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12624 N 58TH DR, GLENDALE, AZ 85304-1894
(314) 718-2790
Mailing address
12624 N 58TH DR, GLENDALE, AZ 85304-1894
(314) 718-2790
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN195491
AZ
Other
Enumeration date
01/08/2021
Last updated
01/08/2021
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