Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 30083138 |
NPI | 1063009090 |
---|---|
Provider Name | Shaina Price |
First Address | Fairview, WV 26570-8616 |
Second Address | Fairview, WV 26570-8616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2020 |
Last Update Date | 23/12/2020 |