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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
20 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-1891
(304) 831-1892
Mailing address
20 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-1891
(304) 831-1892

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
58649
WV
363LF0000X
Family Nurse Practitioner
Primary
107920
WV

Other

Enumeration date
12/01/2020
Last updated
12/08/2020
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