Individual
WANDA J PONCIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2625 MCNUTT RD., SUNLAND PARK, NM 88063-9019
(575) 589-0887
(575) 589-0898
Mailing address
365 CALLE DE ALEGRA, BLDG. A, LAS CRUCES, NM 88005-3417
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
508505
TX
363LF0000X
Family Nurse Practitioner
Primary
CNP01117
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32085273
—
NM
Enumeration date
09/05/2006
Last updated
05/03/2017
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