Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3647 | WV |
NPI | 1003305533 |
---|---|
Provider Name | Dr. Pamela Marie Dewilde |
First Address | Lewisburg, WV 24901-1380 |
Second Address | Lewisburg, WV 24901-1380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 29/11/2021 |