Individual
LEAH D PETRUNGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
150 MISTY LANE, PRINCETON, WV 24740
(304) 425-4040
(304) 425-4041
Mailing address
300 HUNTER PARK, PRINCETON, WV 24740-2533
(304) 920-5122
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
564
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002620
—
WV
Enumeration date
10/02/2006
Last updated
12/08/2016
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