Healthcare Provider Details

I. General information

NPI: 1205746864
Provider Name (Legal Business Name): AMY JO MORT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONE SHANNON RD
WHEELING WV
26003-6742
US

IV. Provider business mailing address

667 STONE SHANNON RD
WHEELING WV
26003-6742
US

V. Phone/Fax

Practice location:
  • Phone: 304-277-4657
  • Fax: 304-277-4657
Mailing address:
  • Phone: 304-277-4657
  • Fax: 304-971-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number177100
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: