Individual
MR. WESLEY SCOTT TRUESDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
106 MEDICAL DRIVE, ELIZ CITY, NC 27909
(252) 338-3002
(252) 338-2902
Mailing address
PO BOX 1471, 106 MEDICAL DRIVE, ELIZ CITY, NC 27909
(252) 338-3002
(252) 338-2902
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
CP001787
NC
332BC3200X
Customized Equipment (DME)
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0482P
BCBS
NC
01
—
384410
BCBS
VA
05
—
7701327
—
NC
05
—
9190511
—
VA
Enumeration date
05/17/2006
Last updated
10/01/2013
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