Provider Demographics
NPI:1477955078
Name:ARISTORENAS, WANDA (FNP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:ARISTORENAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-5148
Mailing Address - Country:US
Mailing Address - Phone:731-926-4222
Mailing Address - Fax:731-926-4228
Practice Address - Street 1:1860 WAYNE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5148
Practice Address - Country:US
Practice Address - Phone:731-926-4222
Practice Address - Fax:731-926-4228
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily