Provider Demographics
NPI:1194189613
Name:LARY, WANDA LAFAY (RN)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:LAFAY
Last Name:LARY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:WANDA
Other - Middle Name:LAFAY
Other - Last Name:BONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2077 MELTON AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-4416
Mailing Address - Country:US
Mailing Address - Phone:478-390-1333
Mailing Address - Fax:
Practice Address - Street 1:2077 MELTON AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4416
Practice Address - Country:US
Practice Address - Phone:478-390-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191453163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse