Individual
TINA RENEE WITHROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
233 MIDWAY ROAD, POCA, WV 25159
(304) 395-6423
Mailing address
PO BOX 535, POCA, WV 25159-0535
(304) 395-6423
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
37594
WV
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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