Individual
CHARLENE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
619 N MAIN ST, MUSKOGEE, OK 74401-4431
(918) 682-8407
Mailing address
PO BOX 635, OKAY, OK 74446-0635
(918) 441-0924
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
205092
OK
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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