Individual
BRIANNA STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 MON GENERAL DR STE 2, MORGANTOWN, WV 26505-2853
(304) 598-5151
Mailing address
712 ASHWORTH LN # 712, MORGANTOWN, WV 26508-5812
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
39348
WV
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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