| NPI | 1407062763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY D MILLER Provider Relations Analyst 304-293-5033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WV 0012053000) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-22 |