Healthcare Provider Details

I. General information

NPI: 1083543862
Provider Name (Legal Business Name): RICHARD CHARLES WOOLLARD II LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 WOOD ST
WHEELING WV
26003-3607
US

IV. Provider business mailing address

1819 WOOD ST
WHEELING WV
26003-3607
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-3500
  • Fax: 304-830-5926
Mailing address:
  • Phone: 304-234-3500
  • Fax: 304-830-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number147162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: