Basic Information
| Provider Information | |||||||||
| NPI: | 1730174095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARRENDELL | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
| FaxNumber: | 6062371701 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
| FaxNumber: | 6062371701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | 30975 | KY | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64051683 | 05 | KY | MEDICAID | 0103292000 | 05 | WV | MEDICAID |