1689769804 NPI number — MRS. WANDA BUFFALOE POTTS RN, RNFA

Table of content: MRS. WANDA BUFFALOE POTTS RN, RNFA (NPI 1689769804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689769804 NPI number — MRS. WANDA BUFFALOE POTTS RN, RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTTS
Provider First Name:
WANDA
Provider Middle Name:
BUFFALOE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, RNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JEFFERS
Provider Other First Name:
WANDA
Provider Other Middle Name:
BUFFALOE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, RNFA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689769804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 BEE CAVES ROAD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-5542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-300-2600
Provider Business Mailing Address Fax Number:
512-300-2602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 BEE CAVES ROAD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-300-2600
Provider Business Practice Location Address Fax Number:
512-300-2602
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WS0121X , with the licence number:  233226 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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