Provider Demographics
NPI:1871288621
Name:PIKE, DANETTE MICHELLE
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:MICHELLE
Last Name:PIKE
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 1:1226 RIDGE RD S
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-0844
Mailing Address - Country:US
Mailing Address - Phone:304-268-7626
Mailing Address - Fax:
Practice Address - Street 1:170 AVIATION WAY STE 102
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-6972
Practice Address - Country:US
Practice Address - Phone:304-261-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23132164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse