Healthcare Provider Details

I. General information

NPI: 1316491996
Provider Name (Legal Business Name): ELLEN PALMER HOBAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN SUE PALMER

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 MEDICAL PARK DR SUITE 105
BRIDGEPORT WV
26330-9008
US

IV. Provider business mailing address

527 MEDICAL PARK DR SUITE 105
BRIDGEPORT WV
26330-9008
US

V. Phone/Fax

Practice location:
  • Phone: 304-933-3885
  • Fax: 304-933-3887
Mailing address:
  • Phone: 304-933-3885
  • Fax: 304-933-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN45835NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: