Most Relevant Information
Provider Data
| NPI Number: | 1003419169 |
| Provider Name: | EILEEN ROSALEE MONGOLD |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/19/2020 |
| Last Updated: | 11/19/2020 |
Provider Practice Location
422 RIDGETOP DR
MOOREFIELD
WV
268368947
Practice Location Phone/Fax
| Phone: | 3047032419 |
| Fax: |
Provider Mailing Location
422 RIDGETOP DR
MOOREFIELD
WV
268368947
Provider Mailing Phone/Fax
| Phone: | 3047032419 |
| Fax: |