Provider Demographics
NPI:1730554213
Name:ZACHARY, WANDA
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:ZACHARY
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 1:220 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5140
Mailing Address - Country:US
Mailing Address - Phone:337-948-0226
Mailing Address - Fax:337-948-0399
Practice Address - Street 1:220 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5140
Practice Address - Country:US
Practice Address - Phone:337-948-0226
Practice Address - Fax:337-948-0399
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator