Provider Demographics
NPI:1689172389
Name:SANDERS, WANDA BRYANT (AGNP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:BRYANT
Last Name:SANDERS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:FAYE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-7779
Practice Address - Country:US
Practice Address - Phone:919-739-4808
Practice Address - Fax:919-739-4810
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC232094363L00000X
NC5010233363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner