Provider Demographics
NPI:1912463837
Name:WAMSLEY, MICHELLE MAHAN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MAHAN
Last Name:WAMSLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ANITA
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1015 FOREST OAK
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-4153
Mailing Address - Country:US
Mailing Address - Phone:361-445-5137
Mailing Address - Fax:
Practice Address - Street 1:800 N SHORELINE BLVD STE 700S
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3718
Practice Address - Country:US
Practice Address - Phone:361-937-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322286164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse