MEDICARE: WANDA FAYE TEMPLE

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
1	372600000X	Adult Companion	HC4175	NC
2	374U00000X	Home Health Aide	HC4175	NC
3	376K00000X	Nurse's Aide	HC4175	NC

General Provider Information

NPI Number	:	1578871034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA FAYE TEMPLE

Provider Business Mailing Address
First Line	:	120 BOGUE LANDING DR
Second Line	:
City	:	NEWPORT
State	:	NC
Zip	:	28570-9313
Country	:	US
Telephone Number	:	252-726-6780
Fax Number	:	252-726-6780

Provider Business Practice Location Address
First Line	:	1403 BRIDGES ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3758
Country	:	US
Telephone Number	:	252-726-6780
Fax Number	:	252-726-6780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2010
Last Update Date	:	09/18/2010

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