Individual
STARLA LYNN WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
675A MORAN LAKE RD NE, ROME, GA 30161-2106
(706) 346-3353
Mailing address
PO BOX 1102, ROME, GA 30162-1102
(706) 346-3353
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN040700
GA
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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