Provider Demographics
NPI:1295103430
Name:WANDA SLAVIN, RNFA
Entity type:Organization
Organization Name:WANDA SLAVIN, RNFA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RNFA
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-303-8534
Mailing Address - Street 1:843 KRYPTONITE DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3081
Mailing Address - Country:US
Mailing Address - Phone:949-303-8534
Mailing Address - Fax:303-663-0152
Practice Address - Street 1:843 KRYPTONITE DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3081
Practice Address - Country:US
Practice Address - Phone:949-303-8534
Practice Address - Fax:303-663-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0177162284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital