Healthcare Provider Details

I. General information

NPI: 1144241092
Provider Name (Legal Business Name): ROANNA T WAYNICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 HELTON DRIVE SUITE A
FLORENCE AL
35630
US

IV. Provider business mailing address

2415 HELTON DRIVE SUITE A
FLORENCE AL
35630
US

V. Phone/Fax

Practice location:
  • Phone: 256-765-2230
  • Fax: 256-765-2084
Mailing address:
  • Phone: 256-765-2230
  • Fax: 256-765-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1047737
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: