Provider Demographics
NPI:1962016485
Name:FIELDS, WANDA DORENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:DORENE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FORTE RD
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-8522
Mailing Address - Country:US
Mailing Address - Phone:910-485-6228
Mailing Address - Fax:910-485-3311
Practice Address - Street 1:114 FORTE RD
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-8522
Practice Address - Country:US
Practice Address - Phone:910-485-6228
Practice Address - Fax:910-485-3311
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily