Provider Demographics
NPI:1407497019
Name:WESLEY, WARNER OLIVER JR
Entity Type:Individual
Prefix:
First Name:WARNER
Middle Name:OLIVER
Last Name:WESLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 HUNT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3619
Mailing Address - Country:US
Mailing Address - Phone:202-415-4791
Mailing Address - Fax:
Practice Address - Street 1:4643 HUNT PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3619
Practice Address - Country:US
Practice Address - Phone:202-415-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant