Individual
JONATHAN P WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 GRANITE POINT DR STE 200, WYOMISSING, PA 19610-1992
(610) 685-9204
Mailing address
PO BOX 6738, WYOMISSING, PA 19610-0738
(610) 988-6060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
78052
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027812500001
—
PA
01
—
108434
GEISINGER
PA
01
—
11803086
CAQH
PA
01
—
1580156
GATEWAY
PA
01
—
1982255
HIGHMARK
PA
01
—
2858756000
IBC
PA
01
—
50069828
CAPITAL ADVANTAGE
PA
01
—
9317982
AETNA
PA
Enumeration date
06/11/2007
Last updated
10/10/2023
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