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Individual provider Active NPI Registered Nurse · Shepherdstown, WV

NPI 1073330320 · NPPES record last updated Oct 1, 2024

Key facts

NPI
1073330320
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
R235166 (MD)
Practice address
301 North King Street
Shepherdstown, WV 25443
Phone
(304) 876-5000
NPI assigned
Sep 26, 2024
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
R235166MDMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R235166 MD Yes

Addresses

Primary practice location

301 North King Street
Shepherdstown, WV 25443

Mailing address

8121 Pennington Dr
Laurel, MD 20724-6120
Phone (443) 421-0186

Other practice location 1

8121 Pennington Dr
Laurel, MD 20724-6120
Phone (443) 421-0186

Other providers in Shepherdstown, WV

All providers in Shepherdstown, WV · Registered Nurse in West Virginia

Sources for this page

Verify at the official NPI Registry.