Most Relevant Information
Provider Data
| NPI Number: | 1003421785 |
| Provider Name: | VADA WILSON |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/10/2020 |
| Last Updated: | 09/10/2020 |
Provider Practice Location
3095 BRUSH COUNTRY RD
MARLINTON
WV
249546880
Practice Location Phone/Fax
| Phone: | 3046369326 |
| Fax: |
Provider Mailing Location
501 WILSON LN
ELKINS
WV
262415216
Provider Mailing Phone/Fax
| Phone: | 3046369326 |
| Fax: |