Provider Demographics
NPI:1366859092
Name:WYCHE, RHANADA SHANAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:RHANADA
Middle Name:SHANAE
Last Name:WYCHE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 TRICE CEMETARY SPUR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-6931
Mailing Address - Country:US
Mailing Address - Phone:706-647-3094
Mailing Address - Fax:
Practice Address - Street 1:1226 TRICE CEMETERY SPUR
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286
Practice Address - Country:US
Practice Address - Phone:706-647-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN075491164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse