| NPI | 1295228161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSIA FUNK Owner/Nurse Practitioner 304-379-7600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 52464) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 81124) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-07-05 |