Healthcare Provider Details

I. General information

NPI: 1619147162
Provider Name (Legal Business Name): JENNIFER NORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEVILLE ST
BECKLEY WV
25801-4511
US

IV. Provider business mailing address

400 NEVILLE ST
BECKLEY WV
25801-4511
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-4712
  • Fax:
Mailing address:
  • Phone: 304-256-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number61141
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: