MEDICARE: MRS. ROBERTA J WHETZEL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	048888	WV

General Provider Information

NPI Number	:	1205866639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBERTA J WHETZEL NP

Provider Business Mailing Address
First Line	:	PO BOX 48
Second Line	:
City	:	ELK GARDEN
State	:	WV
Zip	:	26717-0048
Country	:	US
Telephone Number	:	304-446-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 OAK STREET
Second Line	:
City	:	ELK GARDEN
State	:	WV
Zip	:	26717-0048
Country	:	US
Telephone Number	:	304-446-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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