Organization Name: | LITTLE BEAVER FAMILY CLINIC |
NPI Number: | 1558447805 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHERYL L WHITE (OWNER/PRESIDENT) |
Mailing Address: | 16130 Webster Rd. Craigsville |
State: | WV US |
Postal Code: | 262051728 |
Phone Number: | 3047423570 |
Fax Number: | 3047423572 |
NPI Enumeration Date: | 10/30/2006 |
NPI Last Update Date: | 10/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 52802 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |