NPI | 1790579019 |
---|---|
Entity Type | Organization |
Authorized Contact | ALLISON HENNESSEY Authorized Official 304-276-9254 |
Organization Subpart ? | No |
Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
Additional Taxonomies | 363A00000X Physician Assistant |
363L00000X Nurse Practitioner | |
Enumeration Date | 2025-04-09 |
Last Update Date | 2025-04-09 |