Provider Demographics
NPI:1922826627
Name:CLAY, MIA CLAIRE
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:CLAIRE
Last Name:CLAY
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 1:38 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-1400
Mailing Address - Country:US
Mailing Address - Phone:304-601-2401
Mailing Address - Fax:
Practice Address - Street 1:126 VICKERS RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-4634
Practice Address - Country:US
Practice Address - Phone:304-601-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant