Individual
VICKI DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
761 SUNFLOWER LANE, IVYDALE, WV 25113
(304) 286-5622
Mailing address
761 SUNFLOWER LANE, IVYDALE, WV 25113
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/07/2021
Last updated
04/07/2021
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