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General NPI Number Information
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NPI Number | 1730805888
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Entity Type | Individual
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Provider Name | JESSE LEE DWIER
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Gender | Male
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 1057 6TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-2307
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Country | US
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Telephone | 681-378-6922
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Fax |
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Provider Business Mailing Address
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Address Line | 920 23RD ST
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City | HUNTINGTON
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State | WV
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Zip | 25703-1853
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Country | US
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Telephone | 304-633-4281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | F023895
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License Number State | WV
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