Provider Demographics
NPI:1952025207
Name:NESSELRODT, HANNAH NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:NESSELRODT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FORT PIERPONT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1381
Mailing Address - Country:US
Mailing Address - Phone:304-241-7150
Mailing Address - Fax:304-599-8719
Practice Address - Street 1:1300 FORT PIERPONT DR STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1381
Practice Address - Country:US
Practice Address - Phone:304-241-7150
Practice Address - Fax:304-599-8719
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2740363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical