Provider Demographics
NPI:1578226502
Name:SALYER, WANDA Y (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:Y
Last Name:SALYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 VALLEY CREST CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6569
Mailing Address - Country:US
Mailing Address - Phone:706-940-9178
Mailing Address - Fax:
Practice Address - Street 1:513 VALLEY CREST CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-6569
Practice Address - Country:US
Practice Address - Phone:706-940-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA205543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA205543Medicaid