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General NPI Number Information
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NPI Number | 1427633445
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Entity Type | Organization
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Legal Business Name | ETN MD INC.
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 2401 S KANAWHA ST STE 100
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City | BECKLEY
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State | WV
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Zip | 25801-6967
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Country | US
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Telephone | 202-294-4942
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Fax |
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Provider Business Mailing Address
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Address Line | 105 ROBERT WAY
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City | DANIELS
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State | WV
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Zip | 25832-9051
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Country | US
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Telephone | 202-294-4942
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH T NELSON
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Credential | MD
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Telephone | 202-294-4942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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