Provider Demographics
NPI:1124574504
Name:SLUSHER, MANDY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:SLUSHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSEMAR CIR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1219
Mailing Address - Country:US
Mailing Address - Phone:304-865-5130
Mailing Address - Fax:304-485-1519
Practice Address - Street 1:602 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5656
Practice Address - Country:US
Practice Address - Phone:304-485-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024436363L00000X
WV62667363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner