Provider Demographics
NPI:1124784772
Name:WERKHEISER, TASHA JACLYN
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:JACLYN
Last Name:WERKHEISER
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 1:1106 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2437
Mailing Address - Country:US
Mailing Address - Phone:719-849-5827
Mailing Address - Fax:
Practice Address - Street 1:1106 SUNSET DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2437
Practice Address - Country:US
Practice Address - Phone:719-849-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant