Healthcare Provider Details

I. General information

NPI: 1770549644
Provider Name (Legal Business Name): VENETA ROSE EGGLETON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE
CHARLESTON WV
25302-3302
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE
CHARLESTON WV
25302-3390
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2252
  • Fax: 304-388-2243
Mailing address:
  • Phone: 304-388-2252
  • Fax: 304-388-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number25568
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: