Organization
BRUCETON FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALYSIA FUNK APRN,FNP-BC (OWNER/NURSE PRACTITIONER)
(304) 379-7600
Entity
Organization
Contact information
Practice address
198 MORGANTOWN ST STE 2, BRUCETON MILLS, WV 26525
(304) 379-7600
(304) 379-7599
Mailing address
PO BOX 442, BRUCETON MILLS, WV 26525-0442
(304) 379-7600
(304) 379-7599
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52464
WV
207Q00000X
Family Medicine Physician
81124
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810029631
—
WV
Enumeration date
06/14/2018
Last updated
07/05/2018
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