Provider Demographics
NPI:1811012925
Name:WETSEL, DONALD E (LAC NCTMB)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:WETSEL
Suffix:
Gender:M
Credentials:LAC NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 N LEE HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAIRFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24435-2518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5819 N LEE HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIRFIELD
Practice Address - State:VA
Practice Address - Zip Code:24435-2518
Practice Address - Country:US
Practice Address - Phone:540-377-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist