Provider Demographics
NPI:1689769804
Name:POTTS, WANDA BUFFALOE (RN, RNFA)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:BUFFALOE
Last Name:POTTS
Suffix:
Gender:F
Credentials:RN, RNFA
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:BUFFALOE
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, RNFA
Mailing Address - Street 1:3003 BEE CAVES ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5542
Mailing Address - Country:US
Mailing Address - Phone:512-300-2600
Mailing Address - Fax:512-300-2602
Practice Address - Street 1:3003 BEE CAVES ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5542
Practice Address - Country:US
Practice Address - Phone:512-300-2600
Practice Address - Fax:512-300-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233226163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery