Stephanie Marie Tedrow
Individual provider Active NPI Personal Care Attendant · Pine Grove, WV
NPI 1255112173 · NPPES record last updated Oct 6, 2023
Key facts
- NPI
- 1255112173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 469 Alley Addition St
Pine Grove, WV 26419-8211 - Phone
- (304) 815-2389
- NPI assigned
- Oct 6, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | Yes |
Addresses
Primary practice location
469 Alley Addition St
Pine Grove, WV 26419-8211
Mailing address
469 Alley Addition St
Pine Grove, WV 26419-8211
Phone (304) 815-2389
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356607394 | Medicaid | WV | |
| 125553494 | Medicaid | WV | |
| 1821206228 | Medicaid | WV |
Other providers in Pine Grove, WV
- Heidi Jean Shaw
- Tiffany Starkey
- Gwendolinn Louise Staud
- Tiffany Dawn Stewart
- Casey M Street
- Wetzel County Emergency Ambulance
- Wetzel County Hospital Association
- Wetzel County Hospital, Inc.
All providers in Pine Grove, WV · Personal Care Attendant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.