Provider Demographics
NPI:1417335704
Name:TORRES, WANDA (ANP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1417
Mailing Address - Country:US
Mailing Address - Phone:413-329-9831
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH ST STE 207
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4123
Practice Address - Country:US
Practice Address - Phone:413-499-8510
Practice Address - Fax:413-499-6458
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN254653363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health