=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265459069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA MULICH FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 02/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MEDICAL CENTER DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26506-8227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-598-4446
-----------------------------------------------------
Fax | 304-598-4255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE MEDICAL CENTER DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-598-4446
-----------------------------------------------------
Fax | 304-598-4255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | TP004480B
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 33656
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------