Individual
BRENT WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 W 5TH ST, SHERIDAN, WY 82801-2701
(307) 674-4405
Mailing address
909 LONG DR STE C, SHERIDAN, WY 82801-3282
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
ICPR-028
WY
Other
Enumeration date
12/08/2021
Last updated
12/08/2021
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