Provider Demographics
NPI:1073969952
Name:BOUNDS, WANDA G (RN, BSN, CNOR, RNFA)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:G
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:RN, BSN, CNOR, RNFA
Other - Prefix:MISS
Other - First Name:WANDA
Other - Middle Name:LEE
Other - Last Name:GUEDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, CNOR, RNFA
Mailing Address - Street 1:127 POPLAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8409
Mailing Address - Country:US
Mailing Address - Phone:601-506-2220
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR740713163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1356339OtherCNOR