Provider Demographics
NPI:1861793358
Name:WANDLING, SHANA F (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:F
Last Name:WANDLING
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KOONTZ AVE
Mailing Address - Street 2:
Mailing Address - City:CLENDENIN
Mailing Address - State:WV
Mailing Address - Zip Code:25045-9578
Mailing Address - Country:US
Mailing Address - Phone:304-548-7272
Mailing Address - Fax:304-548-7149
Practice Address - Street 1:6135 SISSONVILLE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-9444
Practice Address - Country:US
Practice Address - Phone:304-984-1576
Practice Address - Fax:304-984-1565
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily