Provider Demographics
NPI:1497349849
Name:MANSFIELD, EARL JEAN
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:JEAN
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 MCCLELLAN HWY
Mailing Address - Street 2:
Mailing Address - City:BRANCHLAND
Mailing Address - State:WV
Mailing Address - Zip Code:25506-8717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4124 MCCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506-8717
Practice Address - Country:US
Practice Address - Phone:304-553-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker