Provider Demographics
NPI:1184958472
Name:DERMATOLOGY CENTER FOR SKIN HEALTH, PLLC
Entity type:Organization
Organization Name:DERMATOLOGY CENTER FOR SKIN HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:WAYBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:304-225-2236
Mailing Address - Street 1:600 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1872
Mailing Address - Country:US
Mailing Address - Phone:304-598-3888
Mailing Address - Fax:304-598-0564
Practice Address - Street 1:600 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1872
Practice Address - Country:US
Practice Address - Phone:304-598-3888
Practice Address - Fax:304-598-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54321363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty