Individual
RUSSELL WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
206 SPRUCE ST, MORGANTOWN, WV 26505-7539
(304) 413-4300
Mailing address
206 SPRUCE ST, MORGANTOWN, WV 26505-7539
(304) 413-4300
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/28/2022
Last updated
07/28/2022
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