Individual
MARY BIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
590 NORTH POPLAR FORK RD, HURRICANE, WV 25526-9434
(304) 757-7826
Mailing address
3573 SLEEPY HOLLOW DR, HURRICANE, WV 25526-9652
(304) 437-1033
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
51658
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51658
RN BOARD
WV
Enumeration date
12/31/2014
Last updated
12/31/2014
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