Provider Demographics
NPI:1073846507
Name:MCCARDLE, NATALLIE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:NATALLIE
Middle Name:LYNN
Last Name:MCCARDLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 MEDICAL PARK
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-6301
Mailing Address - Fax:304-243-8803
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:SUITE 211
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-6301
Practice Address - Fax:304-243-8803
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV66642363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016066Medicaid