Provider Demographics
NPI:1396091708
Name:JONES, WANDA FAY (RN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:FAY
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600-E FARRINGDOM STREET
Mailing Address - Street 2:
Mailing Address - City:LUMB
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2446
Mailing Address - Country:US
Mailing Address - Phone:910-366-6475
Mailing Address - Fax:
Practice Address - Street 1:2006 1/2 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3926
Practice Address - Country:US
Practice Address - Phone:910-366-6475
Practice Address - Fax:910-374-0148
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4515251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health