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NPI Code Detail

MEDICARE: WONDA FAY ELMORE

MEDICARE: WONDA FAY ELMORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71002916BIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000001090820OTHERINANTHEM

General Provider Information

NPI Number : 1053546556
Entity Type Code : Individual
Provider Name (Legal Business Name) : WONDA FAY ELMORE
Provider Business Mailing Address
First Line : 255 N MIAMI ST
Second Line :
City : WABASH
State : IN
Zip : 46992-2705
Country : US
Telephone Number : 574-385-3145
Fax Number : 260-563-1902
Provider Business Practice Location Address
First Line : 255 N MIAMI ST
Second Line :
City : WABASH
State : IN
Zip : 46992-2705
Country : US
Telephone Number : 574-385-3145
Fax Number : 260-563-1902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2009
Last Update Date : 02/14/2024

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Directions to “ WONDA FAY ELMORE ” Practice Location

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