Provider Demographics
NPI:1144589987
Name:WYATT, JANICE LAVERNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LAVERNE
Last Name:WYATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GREAT LAKES DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2394
Mailing Address - Country:US
Mailing Address - Phone:757-850-9730
Mailing Address - Fax:
Practice Address - Street 1:4 GREAT LAKES DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2394
Practice Address - Country:US
Practice Address - Phone:757-850-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001101528163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical