Provider Demographics
NPI:1578076782
Name:AKERS, DOLORES JEAN
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:JEAN
Last Name:AKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DOLORES
Other - Middle Name:JEAN
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:697 BROADWAY RD. (ROAD)
Mailing Address - Street 2:
Mailing Address - City:PIPESTEM
Mailing Address - State:WV
Mailing Address - Zip Code:25979
Mailing Address - Country:US
Mailing Address - Phone:304-466-6243
Mailing Address - Fax:
Practice Address - Street 1:697 BROADWAY RD. (ROAD)
Practice Address - Street 2:
Practice Address - City:PIPESTEM
Practice Address - State:WV
Practice Address - Zip Code:25979
Practice Address - Country:US
Practice Address - Phone:304-466-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG20032656000OtherPROVIDER NUMBER