Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1551 | WV |
NPI | 1003838830 |
---|---|
Provider Name | Marilyn Wendt Horacek |
First Address | Wheeling, WV 26003-3859 |
Second Address | Wheeling, WV 26003-3859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 09/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055267000 | (05) | WV |
080121554 | RAILROAD MEDICARE (01) | |
2057536 | (05) | OH |
G71378 | (02) |