Provider Demographics
NPI:1548588452
Name:WITHROW, PATRICIA W (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:W
Last Name:WITHROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1108
Mailing Address - Country:US
Mailing Address - Phone:304-647-6470
Mailing Address - Fax:304-647-6490
Practice Address - Street 1:202 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1108
Practice Address - Country:US
Practice Address - Phone:304-647-6470
Practice Address - Fax:304-647-6490
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24266163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0161278000Medicaid