Healthcare Provider Details

I. General information

NPI: 1891290144
Provider Name (Legal Business Name): BREANN M SONGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/25/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40823 MIDLAND TRL E
WHITE SULPHUR SPRINGS WV
24986-5064
US

IV. Provider business mailing address

40823 MIDLAND TRL E
WHITE SULPHUR SPRINGS WV
24986-5064
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-4870
  • Fax:
Mailing address:
  • Phone: 304-536-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3710
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: