Street, Wanda Lisa

Street, Wanda Lisa is an individual health care provider with primary practice located at 6600 Van Aalst Blvd , Fort Benning GA 31905-2102. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Psychiatric/Mental Health, Adult, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Street, Wanda Lisa can be contacted via phone (706) 544-8688.

Contact Information

Primary practice address
6600 Van Aalst Blvd Fort Benning GA 31905-2102
Phone: (706) 544-8688
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health, Adult 163WP0809X RN140175 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X RN140175 Georgia

Profile Details

NPI number 1336254648
LBN Legal business name Street, Wanda Lisa
Credentials APRN-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2006
Last updated Dec 29th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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