Provider Demographics
NPI:1538984091
Name:NEAL, EMILY RENEE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:NEAL
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 1:171 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:BIRCH RIVER
Mailing Address - State:WV
Mailing Address - Zip Code:26610-8089
Mailing Address - Country:US
Mailing Address - Phone:304-880-0371
Mailing Address - Fax:
Practice Address - Street 1:64 STATE ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1132
Practice Address - Country:US
Practice Address - Phone:304-364-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV63323163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty