Individual
BREANNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
789 GRASSY RUN RD, FAIRMONT, WV 26554-5925
(304) 669-6137
Mailing address
789 GRASSY RUN RD, FAIRMONT, WV 26554-5925
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
94651
WV
Other
Enumeration date
06/02/2026
Last updated
06/02/2026
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