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Individual

PROF. JACQUELINE GORDON FOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1 MEDICAL PARK, WHEELING, WV 26003-6379
(304) 243-3343
(304) 243-6480
Mailing address
109 MOUNT WOOD RD, WHEELING, WV 26003-2632
(304) 233-2455
(304) 233-6073

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
36659
WV
367500000X
Certified Registered Nurse Anesthetist
SP004405B
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0066453000
WV
05
0943724
OH
05
101239273
PA
Enumeration date
02/09/2006
Last updated
02/20/2015
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