Provider Demographics
NPI:1861408759
Name:KRICK, WANDA FAYE (RN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:FAYE
Last Name:KRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:1750 CEDAR LANE, SUITE 100
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-1866
Mailing Address - Country:US
Mailing Address - Phone:931-455-7779
Mailing Address - Fax:
Practice Address - Street 1:1750 CEDAR LN STE 100
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4760
Practice Address - Country:US
Practice Address - Phone:931-455-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000044411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse