Individual
MRS. BRENDA DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
1 MEDICAL CENTER DRIVE, DEPARTMENT OF PEDIATRICS, MORGANTOWN, WV 26506-9214
(304) 293-1202
Mailing address
1 MEDICAL CENTER DRIVE, DEPARTMENT OF PEDIATRICS, MORGANTOWN, WV 26506-9214
(304) 293-1202
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
25819
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510078
—
WV
05
—
2565460
—
OH
05
—
407133600
—
MD
05
—
78014099
—
KY
Enumeration date
08/23/2006
Last updated
07/08/2007
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