Individual
CODY LEE BRACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4000
Mailing address
4820 BLACKBERRY WAY, PITTSBURGH, PA 15201-2714
(301) 501-2683
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
117089
WV
Other
Enumeration date
01/22/2021
Last updated
08/20/2024
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