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General NPI Number Information
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NPI Number | 1063691293
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Entity Type | Individual
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Provider Name | WANDA IVELLISSE TORRES CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 2815 SOUTH SEACREAST BLVD
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City | BOYTON BEACH
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State | FL
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Zip | 33435
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Country | US
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Telephone | 561-737-7733
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Fax | 561-737-4555
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Provider Business Mailing Address
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Address Line | 214 PALM BEACH PLANTATION BLVD
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-4542
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Country | US
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Telephone | 561-324-9364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9275524
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License Number State | FL
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