Individual
MRS. JENNIFER NICOLE SHOULDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
210 BROOKS ST, SUITE 200, CHARLESTON, WV 25301-1855
(304) 388-1930
(304) 388-1929
Mailing address
210 BROOKS ST, SUITE 200, CHARLESTON, WV 25301-1855
(304) 388-1930
(304) 388-1929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
64722
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810023952
—
WV
01
—
WV1751A
MEDICARE PTAN
WV
Enumeration date
08/17/2012
Last updated
05/08/2015
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