Provider Demographics
NPI:1477715753
Name:RINEHART, ROXANNA L (RN, , CDE)
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:L
Last Name:RINEHART
Suffix:
Gender:F
Credentials:RN, , CDE
Other - Prefix:
Other - First Name:ROXANNA
Other - Middle Name:L
Other - Last Name:PHEASANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:1 MED CTR DR
Mailing Address - Street 2:LOUIS A JOHNSON VAMC
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301
Mailing Address - Country:US
Mailing Address - Phone:304-623-3461
Mailing Address - Fax:
Practice Address - Street 1:1 MED CTR DR
Practice Address - Street 2:LOUIS A JOHNSON VAMC
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36144163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator