Healthcare Provider Details

I. General information

NPI: 1104667997
Provider Name (Legal Business Name): BRIANNA BOLEWARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 506
WEIRTON WV
26062-5054
US

IV. Provider business mailing address

PO BOX 779
MORGANTOWN WV
26507-0779
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3600
  • Fax: 304-981-4908
Mailing address:
  • Phone: 304-797-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number120392
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0036482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: