Provider Demographics
NPI:1639776792
Name:WOLFORD, CHASITY LOUISE
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:LOUISE
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-3033
Mailing Address - Country:US
Mailing Address - Phone:304-956-0142
Mailing Address - Fax:
Practice Address - Street 1:165 BARTON RD
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-3033
Practice Address - Country:US
Practice Address - Phone:304-956-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant