Individual
MONA DIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1157 BOLT RD, FAIRDALE, WV 25839
(681) 459-3155
Mailing address
PO BOX 711, GLEN DANIEL, WV 25844-0711
(681) 459-3115
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/26/2021
Last updated
03/26/2021
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