Kiesha Marie Wine PA-C

NPI 1700113412 - Physician Assistant - 363A00000X

NPI Details
NPI 1700113412
Gender Female
Enumeration Date 11/17/2009
Last Updated 06/17/2016
Entity Type Individual
Active Over 7 years ago
Practice Location
700 OAKMOUND RD
CLARKSBURG WV, 26301-9398, US
Phone (304) 623-6330
Fax (304) 623-6220
Business Location
700 OAKMOUND RD
CLARKSBURG WV, 26301-9398, US
Phone (304) 623-6330
Fax (304) 587-2594
Toxanomy
Taxonomy Code 363A00000X
License State West Virginia
License Number 01444
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According to our database, Kiesha Marie Wine PA-C NPI is 1700113412, taxonomy code is 363A00000X and license number is 01444, license state is located at West Virginia. Kiesha Marie Wine PA-C physically located at 700 Oakmound Rd, Clarksburg WV, 26301-9398. NPI Number Kiesha Marie Wine PA-C has the Individual type.

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1700113412 NPI number is provided on an as is basis without warranty of any kind. 1700113412 is maintained by the National Plan & Provider Enumeration System. The contents of Kiesha Marie Wine PA-C are for informational purposes only.