Individual
MARILYN LAI FANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
110 MORDINGTON AVE, CHARLES TOWN, WV 25414-1693
(304) 267-3595
(304) 267-3599
Mailing address
JEFFERSON COUNTY BOARD OF EDUCATION, 110 MORDINGTON AVENUE, CHARLES TOWN, WV 25414
(304) 267-3595
(304) 267-3599
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
60293
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60293
WV BOARD OF EXAMINERS REGISTERED NURSES
WV
Enumeration date
11/29/2017
Last updated
06/16/2018
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