Individual provider Active NPI

Clarissa Dolenc, FNP-BC

  • Nurse Practitioner
  • Glen Dale, WV
National Provider Identifier
1770350985
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
117964 Issued in WV
Practice address
800 Wheeling Ave
Glen Dale, WV 26038-1660
Phone
(304) 845-3211
NPI assigned
Dec 7, 2023
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 117964 WV Primary

Addresses

Primary practice location

800 Wheeling Ave
Glen Dale, WV 26038-1660

Mailing address

313 5TH St
Glen Dale, WV 26038-1503

Other practice location 1

313 5th St
Glen Dale, WV 26038-1503
Phone (740) 609-3787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250313000281 WV Practitioner - Nurse Practitioner 9335660893 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wheeling Hospital IncGroup PAC ID 5799689493, 433 clinicians
Reynolds Memorial Hospital, IncGroup PAC ID 9830184530, 152 clinicians

Practice addresses (Care Compare)

1 Medical Park
Wheeling, WV 26003-6379

800 Wheeling Ave
Glen Dale, WV 26038-1660
Phone (304) 843-3310

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
117964WVMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reynolds Memorial Hospital, Inc CurrentSince Jan 29, 2025 Accepting new patients

Locations

800 Wheeling Ave
Glen Dale, WV 26038
Phone (304) 221-4520

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1770350985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 5TH ST",
            "city": "GLEN DALE",
            "state": "WV",
            "postal_code": "260381503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WHEELING AVE",
            "city": "GLEN DALE",
            "state": "WV",
            "postal_code": "260381660",
            "telephone_number": "304-845-3211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "313 5th St",
            "address_purpose": "LOCATION",
            "city": "Glen Dale",
            "state": "WV",
            "postal_code": "260381503",
            "country_code": "US",
            "telephone_number": "740-609-3787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLENC",
        "first_name": "CLARISSA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-07",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "117964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Dale, WV

Sources for this page

Verify at the official NPI Registry.