Individual
BONAVENTURE J PORCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(304) 243-3343
Mailing address
1 MEDICAL PARK, WHEELING, WV 26003-6379
(304) 243-3343
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
27755
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065960000
—
WV
05
—
0207026000
—
WV
Enumeration date
07/07/2006
Last updated
12/05/2007
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