Provider Demographics
NPI:1619920600
Name:HORSFORD, M.D., NICHOLE MAUREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:MAUREEN
Last Name:HORSFORD, M.D.
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MAUREEN
Other - Last Name:HORSFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2329
Mailing Address - Country:US
Mailing Address - Phone:304-425-9541
Mailing Address - Fax:304-431-2856
Practice Address - Street 1:151 RT. 52 NORTH
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801
Practice Address - Country:US
Practice Address - Phone:304-436-2106
Practice Address - Fax:304-436-6362
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV211262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVI23253Medicare UPIN