Provider Demographics
NPI:1174799605
Name:WEAVER, HELEN (NNP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2864
Mailing Address - Country:US
Mailing Address - Phone:618-462-8051
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS ROAD
Practice Address - Street 2:ST JOHNS MERCY MEDICAL CENTER NICU
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095530163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care