Healthcare Provider Details

I. General information

NPI: 1275143828
Provider Name (Legal Business Name): AMY BLUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR
MARTINSBURG WV
25401-3402
US

IV. Provider business mailing address

2500 HOSPITAL DR
MARTINSBURG WV
25401-3402
US

V. Phone/Fax

Practice location:
  • Phone: 304-264-1000
  • Fax:
Mailing address:
  • Phone: 304-264-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number68725
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: