Provider Demographics
NPI:1558421685
Name:RAGAN, WANDA (RN)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:RAGAN
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 1:132 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-1659
Mailing Address - Country:US
Mailing Address - Phone:706-867-2727
Mailing Address - Fax:706-867-2739
Practice Address - Street 1:56 SHORT ST # A
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0543
Practice Address - Country:US
Practice Address - Phone:706-867-2727
Practice Address - Fax:706-867-2739
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118147163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health