Healthcare Provider Details

I. General information

NPI: 1558765883
Provider Name (Legal Business Name): JOHN BRANDON ARRUDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26506-4810
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-2706
  • Fax: 304-293-2807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN 75758
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN 75758
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: