Individual
GWENDOLYN NICOLE BAUSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5235 BRACKENRICH DR, CROSS LANES, WV 25313-1639
(304) 419-4450
Mailing address
5235 BRACKENRICH DR, CROSS LANES, WV 25313-1639
(304) 419-4450
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WV
Other
Enumeration date
11/17/2021
Last updated
09/21/2022
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