Divita, Jennifer

Divita, Jennifer is an individual health care provider with primary practice located at 830 Pennsylvania Ave Ste 200, Charleston WV 25302-3302. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Divita, Jennifer can be contacted via phone (304) 388-2709.

Contact Information

Primary practice address
830 Pennsylvania Ave Ste 200 Charleston WV 25302-3302
Phone: (304) 388-2709
Fax: (304) 344-1755
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2474 West Virginia

Profile Details

NPI number 1063646529
LBN Legal business name Divita, Jennifer
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2009
Last updated Feb 19th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063646529 NPPES
West Virginia MEDICAID 3810023323

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