Individual
MR. ETHAN KYLE VIRGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2900 1ST AVE, HUNTINGTON, WV 25702-1241
(304) 526-1234
Mailing address
PO BOX 754, SANDY HOOK, KY 41171-0754
(606) 465-4886
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1145109
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
107258
WV
Other
Enumeration date
04/30/2020
Last updated
12/07/2020
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