Provider Demographics
NPI:1104432624
Name:DOSS, NICOLE LYNN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:DOSS
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:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:SETH
Mailing Address - State:WV
Mailing Address - Zip Code:25181-0172
Mailing Address - Country:US
Mailing Address - Phone:304-837-7897
Mailing Address - Fax:
Practice Address - Street 1:313 CHURCHHILL RD
Practice Address - Street 2:
Practice Address - City:SETH
Practice Address - State:WV
Practice Address - Zip Code:25181
Practice Address - Country:US
Practice Address - Phone:304-837-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant