Healthcare Provider Details

I. General information

NPI: 1447497334
Provider Name (Legal Business Name): CHERYL JO SPAGNUOLO RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL JO WARNE RD, LD

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

IV. Provider business mailing address

3 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

V. Phone/Fax

Practice location:
  • Phone: 304-624-2645
  • Fax:
Mailing address:
  • Phone: 304-624-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number355
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: