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SHANE WRISTON PA-C

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1609277201

Individual Registrant:
 SHANE  WRISTON PA-C
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

Contact information for business:
797 CLINIC DR  IVYDALE, WV 25113-8263 US
Tel: 304-286-4200  Fax: 304-286-2107

Registration Information:
NPI: 1609277201
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical
WV01845

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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