Provider Demographics
NPI:1073088324
Name:KINCHEN, WANDA V (REGISTER NURSE)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:V
Last Name:KINCHEN
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 ELMSHADOW DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4797
Mailing Address - Country:US
Mailing Address - Phone:804-387-7439
Mailing Address - Fax:
Practice Address - Street 1:1005 ELMSHADOW DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-4797
Practice Address - Country:US
Practice Address - Phone:804-387-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001251291163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse