Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN187265 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN187265 | GA |
NPI | 1043467608 |
---|---|
Provider Name | Ms. Michelle Stella Wansky |
First Address | Atlanta, GEORGIA 30368 |
Second Address | Atlanta, GA 30309-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 20/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83-02549 | (02) | CT |