Individual
ISAAC MATTHEW SHEPARD WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
809 LAMONT ST, JOHNSON CITY, TN 37604-5453
(423) 926-1171
Mailing address
224 PARSLEY ST, UNICOI, TN 37692-4110
(423) 534-5328
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
202308
TN
Other
Enumeration date
08/10/2020
Last updated
08/10/2020
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