Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 66498 | WV |
NPI | 1003365446 |
---|---|
Provider Name | Mrs. Anna Besedich |
First Address | Fairview, WV 26570-9384 |
Second Address | Clarksburg, WV 26301-4155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 07/10/2016 |