Provider Demographics
NPI:1497877385
Name:CAPE, WANDA (CNM, MPH)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:CAPE
Suffix:
Gender:F
Credentials:CNM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1417
Mailing Address - Country:US
Mailing Address - Phone:706-282-7676
Mailing Address - Fax:706-886-7280
Practice Address - Street 1:79 DOYLE ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6607
Practice Address - Country:US
Practice Address - Phone:706-282-7676
Practice Address - Fax:706-886-7280
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101692367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife