Individual
TERESA GAYLE WAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
3110 MACCORKLE AVE SE, CHARLESTON, WV 25304
(304) 388-5555
(304) 355-5560
Mailing address
RT 1 BOX 173 K, LIBERTY, WV 25124
(304) 586-3012
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
45590
WV
Other
Enumeration date
08/23/2006
Last updated
06/04/2009
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