Provider Demographics
NPI:1619636594
Name:ARMSTRONG, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S 239TH LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8161
Mailing Address - Country:US
Mailing Address - Phone:602-314-6022
Mailing Address - Fax:602-314-5444
Practice Address - Street 1:822 S 239TH LN
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8161
Practice Address - Country:US
Practice Address - Phone:602-314-6022
Practice Address - Fax:602-314-5444
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant