Provider Demographics
NPI:1801026901
Name:MYERS, WANDA KAY (NP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:KAY
Last Name:MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:KAY
Other - Last Name:VANHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9693
Mailing Address - Country:US
Mailing Address - Phone:989-584-3971
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:102 S 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-5115
Practice Address - Country:US
Practice Address - Phone:989-584-1308
Practice Address - Fax:989-584-0307
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704152301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00874177OtherRAILROAD MEDICARE
MICA8440OtherRAILROAD MEDIARE GROUP PTAN
MIP00874177OtherRAILROAD MEDICARE
MIE96008029Medicare PIN