Provider Demographics
NPI:1033947213
Name:WALDRON, SARIAH DALE
Entity type:Individual
Prefix:
First Name:SARIAH
Middle Name:DALE
Last Name:WALDRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARIAH
Other - Middle Name:
Other - Last Name:GLADWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:110 FOLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1723
Mailing Address - Country:US
Mailing Address - Phone:304-476-2049
Mailing Address - Fax:
Practice Address - Street 1:1322 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1436
Practice Address - Country:US
Practice Address - Phone:304-366-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV119594363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care