Provider Demographics
NPI:1922106426
Name:FUSCHINO, WANDA A (NP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:A
Last Name:FUSCHINO
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:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-786-7158
Mailing Address - Fax:704-784-3307
Practice Address - Street 1:349 PENNY LN NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-786-7158
Practice Address - Fax:704-784-3307
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC940043363LX0001X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922106426Medicaid
NC7006075Medicaid
NC2591087CMedicare PIN
NC2591087CMedicare UPIN
NC1922106426Medicaid
NCNC2378AMedicare PIN
NC7006075Medicaid