Provider Demographics
NPI:1659564714
Name:LANDRY, DENISE (C-FNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARSHALL UNIVERSITY COUNSELING CTR
Mailing Address - Street 2:ONE JOHN MARSHALL DRIVE
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-0001
Mailing Address - Country:US
Mailing Address - Phone:304-696-3111
Mailing Address - Fax:
Practice Address - Street 1:MARSHALL UNIVERSITY COUNSELING CTR
Practice Address - Street 2:ONE JOHN MARSHALL DRIVE
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-0001
Practice Address - Country:US
Practice Address - Phone:304-696-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily