| NPI | 1831503275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI DOLAN Nurse Director 304-645-1787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WV 15358) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 37552) |
| 363L00000X Nurse Practitioner (Licence: WV 53104) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2014-09-18 |