Healthcare Provider Details

I. General information

NPI: 1003629924
Provider Name (Legal Business Name): ANNALEW BLIZZARD WHITE-BARB BA, RN, LCCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 DICK SPENCER RD
FRANKFORD WV
24938-7061
US

IV. Provider business mailing address

459 DICK SPENCER RD
FRANKFORD WV
24938-7061
US

V. Phone/Fax

Practice location:
  • Phone: 304-771-8933
  • Fax:
Mailing address:
  • Phone: 304-771-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number105373
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number105373
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number105373
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: