Provider Demographics
NPI:1326162611
Name:MISORI, WANDA D (APRN,BC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:D
Last Name:MISORI
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MERIDIAN ST N
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4636
Mailing Address - Country:US
Mailing Address - Phone:256-428-7488
Mailing Address - Fax:256-428-7490
Practice Address - Street 1:1110 MERIDIAN ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4636
Practice Address - Country:US
Practice Address - Phone:256-428-7488
Practice Address - Fax:256-428-7490
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1094048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533131OtherBCBS
AL51536160OtherBCBS
AL51533135OtherBCBS
AL51533133OtherBCBS