Provider Demographics
NPI:1740800507
Name:PRITTS, WANDA SUE (RN, CNS)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:SUE
Last Name:PRITTS
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18671 ORIENTE DR APT A
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2579
Mailing Address - Country:US
Mailing Address - Phone:847-877-4053
Mailing Address - Fax:
Practice Address - Street 1:18671 ORIENTE DR APT A
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2579
Practice Address - Country:US
Practice Address - Phone:847-877-4053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse