NPI 1093474991

Brent Weaver

Practitioner Peer Specialist Sheridan, WY

Practice location

Address: 1221 W 5th St, Sheridan, WY 82801-2701
Phone: (307) 674-4405
Mailing address: 909 Long Dr STE C, Sheridan, WY 82801-3282

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence ICPR-028 (WY)

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Registry record

NPI: 1093474991
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 Dec 2021
Record last updated: 8 Dec 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.