Healthcare Provider Details

I. General information

NPI: 1689769804
Provider Name (Legal Business Name): WANDA BUFFALOE POTTS RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WANDA BUFFALOE JEFFERS RN, RNFA

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 BEE CAVES ROAD SUITE 203
AUSTIN TX
78746-5542
US

IV. Provider business mailing address

3003 BEE CAVES ROAD SUITE 203
AUSTIN TX
78746-5542
US

V. Phone/Fax

Practice location:
  • Phone: 512-300-2600
  • Fax: 512-300-2602
Mailing address:
  • Phone: 512-300-2600
  • Fax: 512-300-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number233226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: