NPI 1093284937
Phoenix Rising Healthcare
Practice location
- Address
- 5 Erwin Ln STE a, Fairmont, WV 26554-1376
- Phone
- (304) 366-0111
- Fax
- (304) 366-2099
- Mailing address
- PO Box 1286, Fairmont, WV 26555-1286
Authorised official
- Name
- Traci Tannehill
- Title
- Managing Member of LLC
- Phone
- (304) 366-0111
Registered specialties
Primary Care Nurse Practitioner
Primary
Registry record
- NPI
- 1093284937
- Entity type
- Organization
- NPI issued
- 21 Nov 2018
- Record last updated
- 15 Oct 2020
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.