| NPI | 1164228094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE A WELLS Sr Dir Of Provider Services 304-597-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |