Provider Demographics
NPI:1871017053
Name:WAYNICK-ROGERS, PAMELA RENEE (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:WAYNICK-ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 BRIARWOOD CRST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4353
Mailing Address - Country:US
Mailing Address - Phone:615-243-4054
Mailing Address - Fax:
Practice Address - Street 1:1810 HAYES ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2504
Practice Address - Country:US
Practice Address - Phone:615-321-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6595363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health