Most Relevant Information
Provider Data
| NPI Number: | 1003559766 |
| Provider Name: | NATHAN WILLIAM WAKEFIELD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/19/2022 |
| Last Updated: | 04/19/2022 |
Provider Practice Location
1906 BELLEVIEW AVE SE
ROANOKE
VA
240141838
Practice Location Phone/Fax
| Phone: | 5409817000 |
| Fax: |
Provider Mailing Location
298 WYNDERMERE DR
TROUTVILLE
VA
241756597
Provider Mailing Phone/Fax
| Phone: | 9197278165 |
| Fax: |