Provider Demographics
NPI:1003365446
Name:BESEDICH, ANNA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:BESEDICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:MARCOZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP-C
Mailing Address - Street 1:63 BLAND HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26570-9384
Mailing Address - Country:US
Mailing Address - Phone:304-825-6843
Mailing Address - Fax:
Practice Address - Street 1:1 MED CENTER DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4155
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily