Individual
WYATT EDWARD BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 GRAND CENTRAL MALL STE 4, VIENNA, WV 26105-4100
(304) 485-3300
(304) 485-5584
Mailing address
160 WYNNWOOD DR, MARIETTA, OH 45750-9226
(740) 516-6047
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
111191
WV
Other
Enumeration date
11/17/2021
Last updated
03/24/2025
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