Individual provider · Type 1 NPI

Wanda Lisa Street, APRN-BC

Psychiatric/Mental Health Nurse Practitioner · Fort Benning, GA

NPI number 1336254648 Active

Practice location

6600 Van Aalst Blvd
Fort Benning, GA 31905-2102

Mailing address

1654 Ossahatchie Creek Rd
Ellerslie, GA 31807-5342

Specialties and licenses

TaxonomyCodeLicense
Adult Psychiatric/Mental Health Registered Nurse 163WP0809XRN140175 (GA)
Psychiatric/Mental Health Nurse Practitioner Primary 363LP0808XRN140175 (GA)

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

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About NPI 1336254648

Wanda Lisa Street, APRN-BC's National Provider Identifier is 1336254648, issued on Aug 20, 2006. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Fort Benning, GA. The record was last updated on Dec 29, 2022.