Provider Demographics
NPI:1447766639
Name:MYLES, NANCY CAROL
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CAROL
Last Name:MYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:CAROL
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840
Mailing Address - Country:US
Mailing Address - Phone:304-574-3680
Mailing Address - Fax:
Practice Address - Street 1:171 WOOD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840
Practice Address - Country:US
Practice Address - Phone:304-574-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG30031590000OtherG NUMBER