Provider Demographics
NPI:1558336685
Name:FOLEY, JANN E (CNM)
Entity Type:Individual
Prefix:
First Name:JANN
Middle Name:E
Last Name:FOLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5514
Mailing Address - Country:US
Mailing Address - Phone:304-326-2204
Mailing Address - Fax:304-842-8768
Practice Address - Street 1:200 WEDGEWOOD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2442
Practice Address - Country:US
Practice Address - Phone:304-599-6353
Practice Address - Fax:304-598-3608
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV092367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160105000Medicaid
WV001712494OtherBC/BS
WV001710351OtherBC/BS PAY TO #
WV3610001067Medicaid
WVWV092OtherHEALTH PLAN
WV0160105000Medicaid