Organization
PHOENIX RISING HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TRACI TANNEHILL APRN (MANAGING MEMBER OF LLC)
(304) 366-0111
Entity
Organization
Contact information
Practice address
5 ERWIN LN STE A, FAIRMONT, WV 26554-1376
(304) 366-0111
(304) 366-2099
Mailing address
PO BOX 1286, FAIRMONT, WV 26555-1286
(304) 366-0111
(304) 366-2099
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/21/2018
Last updated
10/15/2020
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