Healthcare Provider Details

I. General information

NPI: 1902154644
Provider Name (Legal Business Name): DONIELLE SUZANNE TETER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US RT 219/250
MILL CREEK WV
26280-0247
US

IV. Provider business mailing address

PO BOX 247
MILL CREEK WV
26280-0247
US

V. Phone/Fax

Practice location:
  • Phone: 304-335-2050
  • Fax: 304-335-6158
Mailing address:
  • Phone: 304-335-2050
  • Fax: 304-335-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58702
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: