Healthcare Provider Details

I. General information

NPI: 1225847668
Provider Name (Legal Business Name): BRENT A PLISKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

IV. Provider business mailing address

15 LINDSAY DR
UNIONTOWN PA
15401-9430
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-1200
  • Fax:
Mailing address:
  • Phone: 724-963-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104810
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number153129
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: