Provider Demographics
NPI:1962194795
Name:LAFFERTY, ADRIA (RN)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:LAFFERTY
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 1:67 CASINO DRIVE, SUITE 104
Mailing Address - Street 2:
Mailing Address - City:ANMOORE
Mailing Address - State:WV
Mailing Address - Zip Code:26323
Mailing Address - Country:US
Mailing Address - Phone:130-420-3247
Mailing Address - Fax:
Practice Address - Street 1:67 CASINO DRIVE
Practice Address - Street 2:
Practice Address - City:ANMOORE
Practice Address - State:WV
Practice Address - Zip Code:26323
Practice Address - Country:US
Practice Address - Phone:304-622-1684
Practice Address - Fax:304-622-0810
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV82211163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse