Healthcare Provider Details

I. General information

NPI: 1487618419
Provider Name (Legal Business Name): MRS. NOLA IRENE VEATCH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WEST LIBERTY STREET
MARTINSBURG OH
43037-0145
US

IV. Provider business mailing address

PO BOX 145
MARTINSBURG OH
43037-0145
US

V. Phone/Fax

Practice location:
  • Phone: 740-294-9684
  • Fax:
Mailing address:
  • Phone: 740-294-9684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2178870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: