Individual
ELLEN L WEAVER-BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
205 PAGE RD, PINEHURST, NC 28374-8749
(910) 295-9211
(910) 235-3428
Mailing address
205 PAGE RD, PINEHURST, NC 28374-8749
(910) 295-5511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01333
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8103120
—
NC
01
—
P00699570
RAILROAD MEDICARE
—
Enumeration date
07/25/2008
Last updated
01/23/2018
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