Provider Demographics
NPI:1366454720
Name:WEAVER, SANDRA L (RN, LCNS)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RN, LCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NEWMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:540-434-2800
Mailing Address - Fax:540-434-2883
Practice Address - Street 1:110 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4004
Practice Address - Country:US
Practice Address - Phone:540-434-2800
Practice Address - Fax:540-434-2883
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001092919163WP0808X
VA0015000490364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA404227OtherTRICARE
VA466967OtherVALUE OPTIONS PROVIDER NO
VAC05754OtherMEDICARE GROUP NUMBER
VA081165OtherSENTARA PROVIDER NUMBER
VA187883OtherCOMPSYCH PROVIDER NUMBER
VA1164637518OtherGROUP NPI NUMBER
VA2028408OtherCIGNA PROVIDER NUMBER
VA005510805Medicaid
VA11527703OtherCAQH
VA117820OtherANTHEM PROVIDER NUMBER
VA005510805Medicaid
VA2028408OtherCIGNA PROVIDER NUMBER