Healthcare Provider Details

I. General information

NPI: 1619944956
Provider Name (Legal Business Name): SYLVIA LOUISE WASDEN NAVY IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NBHC BAHRAIN PSC 451 BOX 340
FPO AE
09834-2800
BH

IV. Provider business mailing address

311 ABERDEEN CIR
SUMMERVILLE SC
29483-7559
US

V. Phone/Fax

Practice location:
  • Phone: 097317854325
  • Fax:
Mailing address:
  • Phone: 844-564-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: