Provider Demographics
NPI:1730330192
Name:WOTRING, SANDRA JANE (RN,MSN,FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:WOTRING
Suffix:
Gender:F
Credentials:RN,MSN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 NOYES AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1351
Mailing Address - Country:US
Mailing Address - Phone:304-345-1341
Mailing Address - Fax:304-345-1336
Practice Address - Street 1:3411 NOYES AVE STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1351
Practice Address - Country:US
Practice Address - Phone:304-345-1341
Practice Address - Fax:304-345-1336
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WONP06082Medicare PIN