Provider Demographics
NPI:1699965210
Name:JAVINS, ELAINE JERRY (RN)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:JERRY
Last Name:JAVINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ASSOCIATION DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1269
Mailing Address - Country:US
Mailing Address - Phone:304-344-3171
Mailing Address - Fax:
Practice Address - Street 1:300 ASSOCIATION DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1269
Practice Address - Country:US
Practice Address - Phone:304-344-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40454163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004840Medicaid