Provider Demographics
NPI:1013529262
Name:COULTER, WANDA ANN
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ANN
Last Name:COULTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 REHMS MOUNTAINTOP RD
Mailing Address - Street 2:
Mailing Address - City:RENICK
Mailing Address - State:WV
Mailing Address - Zip Code:24966-7110
Mailing Address - Country:US
Mailing Address - Phone:304-497-3787
Mailing Address - Fax:
Practice Address - Street 1:399 REHMS MOUNTAINTOP RD
Practice Address - Street 2:
Practice Address - City:RENICK
Practice Address - State:WV
Practice Address - Zip Code:24966-7110
Practice Address - Country:US
Practice Address - Phone:304-497-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant