Healthcare Provider Details

I. General information

NPI: 1972211712
Provider Name (Legal Business Name): MAEZER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COOMBS FARM RD STE 106
MORGANTOWN WV
26508-1157
US

IV. Provider business mailing address

10000 COOMBS FARM RD STE 106
MORGANTOWN WV
26508-1157
US

V. Phone/Fax

Practice location:
  • Phone: 304-212-5663
  • Fax: 304-936-0101
Mailing address:
  • Phone: 304-212-5663
  • Fax: 304-936-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER ONEAL
Title or Position: MEDICAL DIRECTOR
Credential: APRN, CNM, IBCLC
Phone: 304-212-5663