Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN158580 | GA |
NPI | 1003974510 |
---|---|
Provider Name | Wendy Woodward Schaal |
First Address | Atlanta, GA 30307-1813 |
Second Address | Stone Mountain, GA 30083-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |