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Individual

PHYLLIS A ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4000
Mailing address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4000

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
100029
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11006355
FL
367500000X
Certified Registered Nurse Anesthetist
RN286028L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9810009596
WV
Enumeration date
12/20/2006
Last updated
02/01/2021
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