Individual
BRANDON HAROLD WHITEHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
1345 MERCER ST, PRINCETON, WV 24740-3033
(304) 818-2222
Mailing address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 818-2222
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
18-918
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
764876480
—
WV
Enumeration date
04/15/2022
Last updated
04/15/2022
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