Provider Demographics
NPI:1205904638
Name:CABELL, WANDA ANN
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:ANN
Last Name:CABELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 BERTRAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-3134
Mailing Address - Country:US
Mailing Address - Phone:219-989-9135
Mailing Address - Fax:219-845-5594
Practice Address - Street 1:7550 BERTRAM AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-3134
Practice Address - Country:US
Practice Address - Phone:219-989-9135
Practice Address - Fax:219-845-5594
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)