Provider Demographics
NPI:1942690011
Name:HARUNK, WANDA LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:LEE
Last Name:HARUNK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SEABREEZE DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9043
Mailing Address - Country:US
Mailing Address - Phone:339-223-0103
Mailing Address - Fax:
Practice Address - Street 1:524 SEABREEZE DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9043
Practice Address - Country:US
Practice Address - Phone:339-223-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant