| NPI | 1962433177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL BLANKENSHIP Credentialing Processing Manager 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 1222241) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| 207P00000X Emergency Medicine | |
| 207Q00000X Family Medicine | |
| 207Q00000X Family Medicine | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2024-01-15 |