Healthcare Provider Details

I. General information

NPI: 1821638057
Provider Name (Legal Business Name): LEEVETTA LYNN HOLSTEIN APRN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 03/16/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10008 COAL RIVER RD
SETH WV
25181-0611
US

IV. Provider business mailing address

7400 LYNN AVE
HAMLIN WV
25523-1138
US

V. Phone/Fax

Practice location:
  • Phone: 304-837-3399
  • Fax: 304-854-1031
Mailing address:
  • Phone: 304-824-5806
  • Fax: 304-824-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number105405
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: