Healthcare Provider Details

I. General information

NPI: 1073969952
Provider Name (Legal Business Name): WANDA G BOUNDS RN, BSN, CNOR, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WANDA LEE GUEDON RN, BSN, CNOR, RNFA

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

127 POPLAR RIDGE DR
BRANDON MS
39047-8409
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-5437
  • Fax:
Mailing address:
  • Phone: 601-506-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR740713
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: