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General NPI Number Information
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NPI Number | 1629683073
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Entity Type | Individual
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Provider Name | WANDA BYERS OXENDINE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2020
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 20 MEDICAL CAMPUS DR NW STE 105
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City | SUPPLY
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State | NC
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Zip | 28462-4094
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Country | US
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Telephone | 843-839-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 147 PROFESSIONAL LN
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-7878
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Country | US
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Telephone | 843-314-5847
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5013537
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License Number State | NC
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