Provider Demographics
NPI:1740662352
Name:PASERBA, BRITTNY NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRITTNY
Middle Name:NICOLE
Last Name:PASERBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTNY
Other - Middle Name:NICOLE
Other - Last Name:GUDALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:STE 402
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:STE 402
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9008
Practice Address - Country:US
Practice Address - Phone:681-342-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WV1906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant