Provider Demographics
NPI:1255801312
Name:DENNISON, CAROL SUZANNE (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:SUZANNE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8961 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-9362
Mailing Address - Country:US
Mailing Address - Phone:304-589-3241
Mailing Address - Fax:
Practice Address - Street 1:950 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2810
Practice Address - Country:US
Practice Address - Phone:304-436-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN73976NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily