Healthcare Provider Details

I. General information

NPI: 1013956945
Provider Name (Legal Business Name): CONSTANCE J OATES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/09/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST EMERGENCY DEPARTMENT
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

PO BOX 128
WAVERLY WV
26184-0128
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1939
  • Fax: 740-374-1693
Mailing address:
  • Phone: 304-464-4008
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN24642-FNP-BC
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: