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Individual

TAKARA LEEANN MUNCY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
174 LMAH CENTER RD, LOGAN, WV 25601-4058
(304) 792-7130
(304) 792-7146
Mailing address
174 LMAH CENTER RD, LOGAN, WV 25601-4058
(304) 792-7130
(304) 792-7146

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
112055
WV

Other

Enumeration date
02/09/2022
Last updated
03/21/2022
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