=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114250339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WNC MEDICAL STAFFING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2009
-----------------------------------------------------
Last Update Date | 09/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1796 HENDERSONVILLE RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-277-7723
-----------------------------------------------------
Fax | 828-277-7726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1796 HENDERSONVILLE RD 1796 HENDERSONVILLE RD SUITE L
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-277-7723
-----------------------------------------------------
Fax | 828-277-7726
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMIN
-----------------------------------------------------
Name | MS. YOLANDA YVETTE BLAIR
-----------------------------------------------------
Credential | NURSE
-----------------------------------------------------
Telephone | 828-277-7723
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HC3119
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------