Provider Demographics
NPI:1275349235
Name:DODGE, VIRGINIA ANN
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:DODGE
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 1:442 TANK BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MORGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25813-7513
Mailing Address - Country:US
Mailing Address - Phone:850-417-1952
Mailing Address - Fax:
Practice Address - Street 1:442 TANK BRANCH RD
Practice Address - Street 2:
Practice Address - City:GLEN MORGAN
Practice Address - State:WV
Practice Address - Zip Code:25813-7513
Practice Address - Country:US
Practice Address - Phone:850-417-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant