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General NPI Number Information
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NPI Number | 1396202479
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Entity Type | Individual
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Provider Name | RACHAEL M GEORGE ODUTAYO NP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 310 AMERICAN WAY STE A
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City | WEIRTON
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State | WV
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Zip | 26062-4083
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Country | US
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Telephone | 304-797-6410
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Fax | 304-797-6320
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Provider Business Mailing Address
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Address Line | 310 AMERICAN WAY STE A
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City | WEIRTON
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State | WV
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Zip | 26062-4083
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Country | US
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Telephone | 843-206-2031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 103156
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License Number State | WV
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