Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 78672 | WV |
NPI | 1215309380 |
---|---|
Provider Name | Cierra Kochy |
First Address | Morgantown, WV 26508-5940 |
Second Address | Morgantown, WV 26506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |