Provider Demographics
NPI:1821823402
Name:INCE, WANDA E
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:E
Last Name:INCE
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 1:2 BROAD ST STE 208
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2548
Mailing Address - Country:US
Mailing Address - Phone:973-338-0124
Mailing Address - Fax:973-338-0080
Practice Address - Street 1:2 BROAD ST STE 208
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2548
Practice Address - Country:US
Practice Address - Phone:973-338-0124
Practice Address - Fax:973-338-0080
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health