Individual
NICHOLE S WAZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PRSS
Contact information
Practice address
408 TENNESSEE AVE, CHARLESTON, WV 25302-2338
(304) 413-4300
Mailing address
408 TENNESSEE AVE, CHARLESTON, WV 25302-2338
(304) 413-4300
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24-938
WV
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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