Healthcare Provider Details

I. General information

NPI: 1437328259
Provider Name (Legal Business Name): MRS. KATHRYN VERZICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 JEFFERSON AVE
PETERSBURG WV
26847-1628
US

IV. Provider business mailing address

HC 78 BOX 96A
RIVERTON WV
26814-9709
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-1011
  • Fax:
Mailing address:
  • Phone: 304-567-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number24587
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: