Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 104046 | WV |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 104046 | WV |
N | 363LP2300X | Nurse Practitioner - Primary Care | 104046 | WV |
NPI | 1538712138 |
---|---|
Provider Name | Yezenia Soto |
First Address | Saint Albans, WV 25177-2423 |
Second Address | South Charleston, WV 25309-1319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 21/08/2019 |