Basic Information
| Provider Information | |||||||||
| NPI: | 1306397088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | METTA | ||||||||
| MiddleName: | KATHERINE LEE | ||||||||
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| Credential: | APRN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24547 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287078404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2112 E FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836429024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007690045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 54221 | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.