Provider Demographics
NPI:1902247752
Name:WEAVER, DIANE L (DNP)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7880 LINCOLE PL
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8322
Mailing Address - Country:US
Mailing Address - Phone:330-424-7221
Mailing Address - Fax:330-424-3731
Practice Address - Street 1:7880 LINCOLE PL
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8322
Practice Address - Country:US
Practice Address - Phone:330-424-5686
Practice Address - Fax:330-424-4012
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH14665-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115767Medicaid
OHH463480Medicare PIN