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Dr. Mallory Weaver, DO
Student in an Organized Health Care Education/Training Program in Peoria, Illinois
NPI 1376235861

Mallory Weaver is a Student in an Organized Health Care Education/Training Program based in East Peoria, IL. Mallory Weaver practices in Peoria, IL and has the professional credentials of DO. The NPI Number for Mallory Weaver is 1376235861 and holds a License No. 90200000X (Illinois).

The current practice location address for Mallory Weaver is 815 Main St Ste C, Peoria, IL and can be reached out via phone at 309-672-4977.

Location: 815 Main St Ste C, Peoria, IL, 61611-1281
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1376235861
Provider Name
Mallory Weaver
Credential
DO
Provider Entity Type
Individual
Gender
Female
Address
815 Main St Ste C, Peoria, IL, 61611-1281
Phone Number
309-672-4977
Fax Number
Provider Enumeration Date
05/23/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
815 Main St Ste C
City
Peoria
State
Illinois
Zip
61602-1080
Phone Number
309-672-4977
Fax Number
person
Provider Business Mailing Address Details
Address
815 Main St Ste C
City
Peoria
State
Illinois
Zip
61602-1080
Phone Number
309-672-4977
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
90200000X ()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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