Provider Demographics
NPI:1154812196
Name:FARMER, WANDA MARIA
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:MARIA
Last Name:FARMER
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:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:DOSWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23047-0201
Mailing Address - Country:US
Mailing Address - Phone:804-564-1496
Mailing Address - Fax:
Practice Address - Street 1:10362 PLEASANTS CIRCLE
Practice Address - Street 2:
Practice Address - City:DOSWELL
Practice Address - State:VA
Practice Address - Zip Code:23047
Practice Address - Country:US
Practice Address - Phone:804-564-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care