Healthcare Provider Details

I. General information

NPI: 1255801312
Provider Name (Legal Business Name): CAROL SUZANNE DENNISON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MOUNT VIEW RD
WELCH WV
24801-2810
US

IV. Provider business mailing address

8961 NEW HOPE RD
BLUEFIELD WV
24701-9362
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-4798
  • Fax:
Mailing address:
  • Phone: 304-589-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN73976NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: