Provider Demographics
NPI:1386084507
Name:WONSETTLER, JOSEPH LAWRENCE (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAWRENCE
Last Name:WONSETTLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 STAUNTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1327
Mailing Address - Country:US
Mailing Address - Phone:304-388-6004
Mailing Address - Fax:304-388-3360
Practice Address - Street 1:3412 STAUNTON AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1327
Practice Address - Country:US
Practice Address - Phone:304-388-6004
Practice Address - Fax:304-388-3360
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1756363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2998AMedicare PIN