Healthcare Provider Details

I. General information

NPI: 1649521758
Provider Name (Legal Business Name): JOHN MICHAEL HUBER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MEMORIAL CHURCH DR
MORGANTOWN WV
26501-1503
US

IV. Provider business mailing address

1000 MON HEALTH MEDICAL PARK DR STE 1201
MORGANTOWN WV
26505-1143
US

V. Phone/Fax

Practice location:
  • Phone: 304-292-7316
  • Fax: 304-599-8917
Mailing address:
  • Phone: 304-599-9400
  • Fax: 304-599-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76465
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: