Individual
JEREMY MICHAEL WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN,APNP
Contact information
Practice address
923 ELIZA ST, GREEN BAY, WI 54301-3234
(920) 965-4800
(920) 965-4801
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13109-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F07220382
AMERICAN ACADEMY NURSE PRACTITIONERS
—
Enumeration date
07/26/2022
Last updated
09/02/2022
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