Provider Demographics
NPI:1851873376
Name:WADSLEY, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:WADSLEY
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 1:178 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9744
Mailing Address - Country:US
Mailing Address - Phone:610-806-6055
Mailing Address - Fax:
Practice Address - Street 1:178 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9744
Practice Address - Country:US
Practice Address - Phone:610-806-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
R60025828OtherBLUE CROSS BLUE SHIELD