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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Christina Elaine Jack | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Christina Elaine | [sources] | |||
| Last name | Jack | [sources] | |||
| NPI | 1811565542 | [sources] | |||
| Address | 5341 Clear Fork Road, Dorothy, WV 25060 | [sources] | |||
| Last change | Last processed | First seen | |||
Medicaid providers sanctioned in West Virginia's Medicaid program.
United States · MMIS
For experts: raw data explorer
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| Address | ||
|---|---|---|
| Full address | Country | |
| 5341 Clear Fork Road, Dorothy, WV 25060 | United States | |