| NPI | 1346316395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELORES A LUCKY Nurse Practitioner 304-872-3654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WV 44396) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-07-21 |