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Individual

LAURA WAIALAE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
10 MEDICAL PARK, SUITE 101, WHEELING, WV 26003
(304) 243-3889
(304) 243-8802
Mailing address
10 MEDICAL PARK, SUITE 101, WHEELING, WV 26003
(304) 243-3889
(304) 243-8802

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2199
WV
363AM0700X
Medical Physician Assistant
363AS0400X
Surgical Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0313358
OH
Enumeration date
07/12/2018
Last updated
06/03/2020
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