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General NPI Number Information
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NPI Number | 1487443750
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Entity Type | Individual
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Provider Name | DORETHEA L TAYLOR-HENSHAW RN
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Gender | Female
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 4605 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1311
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Country | US
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Telephone | 304-766-3971
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Fax |
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Provider Business Mailing Address
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Address Line | 118 LITCHFIELD LN
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City | HURRICANE
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State | WV
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Zip | 25526-8851
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Country | US
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Telephone | 304-941-9590
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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 | 163WX0003X
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Taxonomy Name | Inpatient Obstetric Registered Nurse
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License Number | 111971
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License Number State | WV
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