Individual
PATRICIA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
87 SWIERKOS DR, MOUNDSVILLE, WV 26041-4209
(304) 843-2306
(304) 843-2308
Mailing address
4400 EOFF ST, WHEELING, WV 26003-4420
(304) 843-2306
(304) 843-2308
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114118973
—
WV
05
—
1255523494
—
WV
05
—
1356607394
—
WV
05
—
1710243753
—
WV
05
—
1821206228
—
WV
Enumeration date
07/21/2020
Last updated
07/21/2020
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