Healthcare Provider Details

I. General information

NPI: 1730003559
Provider Name (Legal Business Name): MABLUGHA BURHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 COMMERCE DR STE 208
MORGANTOWN WV
26501-3858
US

IV. Provider business mailing address

11 COMMERCE DR STE 208
MORGANTOWN WV
26501-3858
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-5500
  • Fax: 304-285-2787
Mailing address:
  • Phone: 304-285-5500
  • Fax: 304-285-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number105966
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: