Most Relevant Information
Provider Data
| NPI Number: | 1003569559 |
| Provider Name: | ANGEL LANIE MCDIVITT |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/03/2022 |
| Last Updated: | 02/03/2022 |
Provider Practice Location
172 MAIN STREET
CLAY
WV
250432504
Practice Location Phone/Fax
| Phone: | 3045874251 |
| Fax: |
Provider Mailing Location
PO BOX 455
CLAY
WV
250430455
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |