Individual
MISS CELICIA NACHELLE FRUIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
204 OAKMONT WAY, MOUNT HOPE, WV 25880-9492
(304) 640-2917
Mailing address
204 OAKMONT WAY, MOUNT HOPE, WV 25880-9492
(304) 640-2917
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A01844
MD
174400000X
Specialist
C1787
WV
Other
Enumeration date
04/19/2011
Last updated
04/19/2011
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