Provider Demographics
NPI:1427774306
Name:MCNAIR, WANDA DENISE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:DENISE
Last Name:MCNAIR
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 1:1500 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5455
Mailing Address - Country:US
Mailing Address - Phone:954-709-5720
Mailing Address - Fax:
Practice Address - Street 1:1001 W CYPRESS CREEK RD STE 302N
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1950
Practice Address - Country:US
Practice Address - Phone:954-709-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31954Medicaid