Individual
MR. TRAVIS WADE MAULE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, FNP-C
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 632-6993
Mailing address
1 RIVERSIDE CIRCLE, 4TH FLOOR EMERGENCY DEPARTMENT ADMINISTRATION, ROANOKE, VA 24016
(210) 445-5188
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0024175680
VA
363L00000X
Nurse Practitioner
Primary
0024175680
VA
Other
Enumeration date
09/25/2017
Last updated
08/29/2022
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