Healthcare Provider Details

I. General information

NPI: 1225730955
Provider Name (Legal Business Name): COURTNEY BRETT ROSENCRANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 UNIVERSITY TOWN CENTRE DR
MORGANTOWN WV
26501-2421
US

IV. Provider business mailing address

6040 UNIVERSITY TOWN CENTRE DR
MORGANTOWN WV
26501-2421
US

V. Phone/Fax

Practice location:
  • Phone: 855-988-2273
  • Fax: 304-293-1216
Mailing address:
  • Phone: 855-988-2273
  • Fax: 304-293-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36698
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: