Healthcare Provider Details

I. General information

NPI: 1811186893
Provider Name (Legal Business Name): CARLA S. DUNAWAY APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWNE CENTRE SUITE 310
MORGANTOWN WV
26505-1872
US

IV. Provider business mailing address

600 SUNCREST TOWNE CENTRE SUITE 310
MORGANTOWN WV
26505-1872
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2200
  • Fax: 304-599-2674
Mailing address:
  • Phone: 304-598-2200
  • Fax: 304-599-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number30709
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN567961
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: