Healthcare Provider Details

I. General information

NPI: 1659265213
Provider Name (Legal Business Name): EVA WYCOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 DUNKARD MILL RD
FARMINGTON WV
26571-8168
US

IV. Provider business mailing address

123 GLADES RUN RD
FAIRVIEW WV
26570-9326
US

V. Phone/Fax

Practice location:
  • Phone: 304-612-6507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: