=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861869638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALECIA HATHAWAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2015
-----------------------------------------------------
Last Update Date | 08/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 CHAPLINE ST
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-3875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-232-7151
-----------------------------------------------------
Fax | 304-232-6128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 WILLETA AVE
-----------------------------------------------------
City | MARTINS FERRY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43935-1252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 25253
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------