Individual
MIA R WESSELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, SUITE 101B, ABINGDON, VA 24211-7664
(276) 258-1777
(276) 258-1776
Mailing address
16000 JOHNSTON MEMORIAL DR, SUITE 101B, ABINGDON, VA 24211-7664
(276) 258-1777
(276) 258-1776
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101040882
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005997445
—
VA
01
—
039404
ANTHEM
VA
01
—
TN0101
JOHN DEERE
—
Enumeration date
01/04/2006
Last updated
02/28/2017
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