Provider Demographics
NPI:1952352858
Name:MEADOWS, SUE A (RN, MSN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PINNELL ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-9101
Mailing Address - Country:US
Mailing Address - Phone:304-373-1578
Mailing Address - Fax:304-372-2749
Practice Address - Street 1:122 PINNELL ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9101
Practice Address - Country:US
Practice Address - Phone:304-373-1578
Practice Address - Fax:304-372-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV0281AOtherMEDICARE PTAN
WV7102039000Medicaid
WV9328803OtherGROUP PTAN
WV17631Medicare PIN
WV9328803OtherGROUP PTAN
WV513410Medicare Oscar/Certification