Provider Demographics
NPI:1396734554
Name:MCFATTER, WANDA JEAN (CNM)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:JEAN
Last Name:MCFATTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST STE 605
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1541
Mailing Address - Country:US
Mailing Address - Phone:719-556-5586
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:559 VINCENT ST STE 605
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-556-5586
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2030282176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife