Individual
WANDA EUBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, RN
Contact information
Practice address
380 SUWANNEE TRAIL STREET, BOWLING GREEN, KY 42103
(270) 901-5000
Mailing address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
(270) 842-5268
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1869
KY
163W00000X
Registered Nurse
1055267
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100287840
—
KY
Enumeration date
05/09/2006
Last updated
12/15/2017
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