Individual
MOLLY JO WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5318
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025887900
—
NE
05
—
1750553632
—
SD
05
—
1750553632
—
WY
05
—
200743430A
—
KS
05
—
60871334
—
CO
Enumeration date
03/31/2008
Last updated
01/26/2022
Update your record
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