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General NPI Number Information
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NPI Number | 1942288501
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Entity Type | Individual
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Provider Name | MIA R WESSELS MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 16000 JOHNSTON MEMORIAL DR SUITE 101B
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-1777
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Fax | 276-258-1776
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Provider Business Mailing Address
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Address Line | 16000 JOHNSTON MEMORIAL DR SUITE 101B
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-1777
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Fax | 276-258-1776
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101040882
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License Number State | VA
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