Provider Demographics
NPI:1992091698
Name:NANCE, WILMA LARETTA (MSE)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:LARETTA
Last Name:NANCE
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BALCOM LN
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-9502
Mailing Address - Country:US
Mailing Address - Phone:870-483-1461
Mailing Address - Fax:
Practice Address - Street 1:1005 BALCOM LN
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9502
Practice Address - Country:US
Practice Address - Phone:870-483-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist