Provider Demographics
NPI:1013754548
Name:BRITNER, THERESA ANN
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:BRITNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:GREAT CACAPON
Mailing Address - State:WV
Mailing Address - Zip Code:25422-3235
Mailing Address - Country:US
Mailing Address - Phone:304-820-6355
Mailing Address - Fax:
Practice Address - Street 1:3205 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:GREAT CACAPON
Practice Address - State:WV
Practice Address - Zip Code:25422-3235
Practice Address - Country:US
Practice Address - Phone:304-820-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant