Provider Demographics
NPI:1598265456
Name:VINSON, WANDA (LVN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:VINSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 NONESUCH RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1562
Mailing Address - Country:US
Mailing Address - Phone:325-669-7666
Mailing Address - Fax:
Practice Address - Street 1:2726 NONESUCH RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1562
Practice Address - Country:US
Practice Address - Phone:325-669-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324348164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse