Individual
GWENDOLYN J MILLESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 HOSPITAL DR, ATHENS, OH 45701-2302
(740) 592-9349
Mailing address
27 UTAH PL, ATHENS, OH 45701-1458
(740) 594-8770
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20341
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1054725
WV WORK COMP
WV
01
—
2216364
OHIO MEDICAID
OH
05
—
3810001713
—
WV
Enumeration date
06/05/2006
Last updated
07/08/2007
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