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SHANE WRISTON PA-C
Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1609277201
Individual Registrant: SHANE WRISTON PA-C
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
797 CLINIC DR IVYDALE, WV 25113-8263 US
Tel: 304-286-4200 Fax: 304-286-2107
Tel: 304-286-4200 Fax: 304-286-2107
Contact information for business:
797 CLINIC DR IVYDALE, WV 25113-8263 US
Tel: 304-286-4200 Fax: 304-286-2107
Tel: 304-286-4200 Fax: 304-286-2107
Registration Information:
NPI: 1609277201
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Medical | WV | 01845 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
