Individual
WANETTA SUSIE MATULIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
68 QUARRY RDG, CHARLESTON, WV 25304-1051
(304) 344-5000
Mailing address
68 QUARRY RDG, CHARLESTON, WV 25304-1051
(304) 344-5000
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
14892
WV
Other
Enumeration date
11/12/2012
Last updated
11/12/2012
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