Provider Demographics
NPI:1306344411
Name:ALDERMAN, WYONNA JUNE (PCA)
Entity type:Individual
Prefix:
First Name:WYONNA
Middle Name:JUNE
Last Name:ALDERMAN
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:
Other - Last Name:HEDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 132ND STREET
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:WV
Mailing Address - Zip Code:25315
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:124 132ND STREET
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:WV
Practice Address - Zip Code:25315
Practice Address - Country:US
Practice Address - Phone:304-949-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant