Healthcare Provider Details

I. General information

NPI: 1285703108
Provider Name (Legal Business Name): JEFFREY LEE ROWE ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 US ROUTE 60 E RADIOLOGY, INC.
HUNTINGTON WV
25705-2022
US

IV. Provider business mailing address

PO BOX 910
HUNTINGTON WV
25712-0910
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1550
  • Fax: 304-522-0704
Mailing address:
  • Phone: 304-522-1550
  • Fax: 304-522-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number66701
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number66701
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: