Provider Demographics
NPI:1750600524
Name:HORN, WANDA L (MHNP)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:L
Last Name:HORN
Suffix:
Gender:F
Credentials:MHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HWY 25 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63825-9566
Mailing Address - Country:US
Mailing Address - Phone:573-568-7377
Mailing Address - Fax:573-568-7320
Practice Address - Street 1:612 STATE HIGHWAY 25 S
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:63825-9566
Practice Address - Country:US
Practice Address - Phone:573-803-3995
Practice Address - Fax:573-803-5222
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO126560OtherMISSOURI STATE BOARD OF NURSING LICENSE