Provider Demographics
NPI:1649233099
Name:ANDERSON, WANDA KAY (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-3122
Mailing Address - Country:US
Mailing Address - Phone:262-632-9290
Mailing Address - Fax:262-632-9296
Practice Address - Street 1:1629 OHIO STREET
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-3122
Practice Address - Country:US
Practice Address - Phone:262-632-9290
Practice Address - Fax:262-632-9296
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse