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General NPI Number Information
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NPI Number | 1528539285
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Entity Type | Individual
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Provider Name | ELIZABETH ANN MASTERS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DRIVE
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City | CLARKSBURG
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State | WV
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Zip | 26301
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Country | US
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Telephone | 304-623-3461
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 FREEDOM HWY APT 8A
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City | FAIRMONT
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State | WV
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Zip | 26554-0211
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Country | US
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Telephone | 304-680-1910
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 76055
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License Number State | WV
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