Provider Demographics
NPI:1669164166
Name:WAJLER, GRACE ANNA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNA
Last Name:WAJLER
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 1:201 GREY FLATS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5874
Mailing Address - Country:US
Mailing Address - Phone:304-255-7676
Mailing Address - Fax:304-929-6007
Practice Address - Street 1:155 MAHOGANY RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:WV
Practice Address - Zip Code:26570-6091
Practice Address - Country:US
Practice Address - Phone:681-385-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant