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General NPI Number Information
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NPI Number | 1588178511
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Entity Type | Individual
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Provider Name | MARILYN LAI FANG RN
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Gender | Female
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 110 MORDINGTON AVE
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City | CHARLES TOWN
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State | WV
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Zip | 25414-1693
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Country | US
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Telephone | 304-267-3595
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Fax | 304-267-3599
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Provider Business Mailing Address
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Address Line | JEFFERSON COUNTY BOARD OF EDUCATION 110 MORDINGTON AVENUE
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City | CHARLES TOWN
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State | WV
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Zip | 25414
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Country | US
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Telephone | 304-267-3595
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Fax | 304-267-3599
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 60293
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License Number State | WV
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