Provider Demographics
NPI:1609825876
Name:WAKELAND, ELAINE M (CNM)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:WAKELAND
Suffix:
Gender:F
Credentials:CNM
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 248
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0248
Mailing Address - Country:US
Mailing Address - Phone:931-766-4560
Mailing Address - Fax:931-762-8106
Practice Address - Street 1:1605 S LOCUST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4061
Practice Address - Country:US
Practice Address - Phone:931-766-4560
Practice Address - Fax:931-762-8206
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008220367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4042797OtherBCBS