Provider Demographics
NPI:1467232793
Name:DEITZ, CADY
Entity Type:Individual
Prefix:
First Name:CADY
Middle Name:
Last Name:DEITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CADY
Other - Middle Name:
Other - Last Name:MESSENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2044 MOUNTAIN ASH LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-1135
Mailing Address - Country:US
Mailing Address - Phone:304-709-2239
Mailing Address - Fax:
Practice Address - Street 1:186 FAIRCHANCE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4435
Practice Address - Country:US
Practice Address - Phone:304-777-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV117128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily