Healthcare Provider Details

I. General information

NPI: 1720757230
Provider Name (Legal Business Name): RAIZEL JENICA ESSICK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAIZEL CHENG

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MOUNT DE CHANTAL RD STE 200
WHEELING WV
26003-6328
US

IV. Provider business mailing address

PO BOX 644118
PITTSBURGH PA
15264-4118
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-0707
  • Fax: 304-243-0841
Mailing address:
  • Phone: 304-243-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3215
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062712
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: