Healthcare Provider Details

I. General information

NPI: 1740269844
Provider Name (Legal Business Name): LAURA MAHONY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301-6 GREAT TEAYS BLVD
SCOTT DEPOT WV
25560
US

IV. Provider business mailing address

301-6 GREAT TEAYS BLVD
SCOTT DEPOT WV
25560
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6999
  • Fax: 304-757-3252
Mailing address:
  • Phone: 304-757-6999
  • Fax: 304-757-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number33777
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number034
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: