Provider Demographics
NPI:1811968662
Name:DEEL, WILMA (NP)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:DEEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W MORGAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PENNINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24277-2036
Mailing Address - Country:US
Mailing Address - Phone:276-546-5310
Mailing Address - Fax:
Practice Address - Street 1:208 FRONT ST W
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-3502
Practice Address - Country:US
Practice Address - Phone:276-455-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024125484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily