Provider Demographics
NPI:1760142475
Name:WESOLOSKI, ERIK JAMES
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:JAMES
Last Name:WESOLOSKI
Suffix:
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 1:10 W RUN RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0059
Mailing Address - Country:US
Mailing Address - Phone:304-621-2448
Mailing Address - Fax:
Practice Address - Street 1:10 W RUN RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0059
Practice Address - Country:US
Practice Address - Phone:304-621-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant