Basic Information
| Provider Information | |||||||||
| NPI: | 1861793358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANDLING | ||||||||
| FirstName: | SHANA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | RN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 KOONTZ AVE | ||||||||
| Address2: | |||||||||
| City: | CLENDENIN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250459578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045487272 | ||||||||
| FaxNumber: | 3045487149 | ||||||||
| Practice Location | |||||||||
| Address1: | 6135 SISSONVILLE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253129444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049841576 | ||||||||
| FaxNumber: | 3049841565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2010 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 58591 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.