Healthcare Provider Details

I. General information

NPI: 1730330192
Provider Name (Legal Business Name): SANDRA JANE WOTRING RN,MSN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 NOYES AVE STE A
CHARLESTON WV
25304-1351
US

IV. Provider business mailing address

3411 NOYES AVE STE A
CHARLESTON WV
25304-1351
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-1341
  • Fax: 304-345-1336
Mailing address:
  • Phone: 304-345-1341
  • Fax: 304-345-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18628
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: