Healthcare Provider Details

I. General information

NPI: 1932757044
Provider Name (Legal Business Name): NANCY LEIGH RODRIGUEZ CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2019
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S SEMINARY ST
CHARLES TOWN WV
25414-1347
US

IV. Provider business mailing address

754 APPLE CROSS RD
HARPERS FERRY WV
25425-3219
US

V. Phone/Fax

Practice location:
  • Phone: 304-839-1262
  • Fax:
Mailing address:
  • Phone: 301-318-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: