Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23026 | WV |
NPI | 1003093097 |
---|---|
Provider Name | Aimee M Whitehair |
First Address | Rock Cave, WV 26234-0217 |
Second Address | Rockcave, WV 26234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 22/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810012219 | (05) | WV |