Healthcare Provider Details

I. General information

NPI: 1003980129
Provider Name (Legal Business Name): LOUISE NAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARSTON WV
25304
US

IV. Provider business mailing address

3598 CREDE DR
CHARLESTON WV
25302
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4077
  • Fax: 304-388-9852
Mailing address:
  • Phone: 304-343-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16052
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number15710
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: