Provider Demographics
NPI:1154532018
Name:LAFOREST, WENDY WIMBROW (PNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:WIMBROW
Last Name:LAFOREST
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10626 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4703
Mailing Address - Country:US
Mailing Address - Phone:865-577-5231
Mailing Address - Fax:865-577-1539
Practice Address - Street 1:10626 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4703
Practice Address - Country:US
Practice Address - Phone:865-577-5231
Practice Address - Fax:865-577-1539
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012720363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000012720OtherAPN