MEDICARE: AUDREY WAND

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	363LP2300X	Primary Care Nurse Practitioner	AP138098	TX
2	163W00000X	Registered Nurse	857866	TX

General Provider Information

NPI Number	:	1790275949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY WAND

Provider Business Mailing Address
First Line	:	325 N. ST. PAUL STREET
Second Line	:	SUITE 3100
City	:	DALLAS
State	:	TX
Zip	:	75201
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 N. ST. PAUL STREET
Second Line	:	SUITE 3100
City	:	DALLAS
State	:	TX
Zip	:	75201
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	02/14/2026

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Directions to “ AUDREY WAND ” Practice Location

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