Individual
WANDA S SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
105 GAY ST, ERWIN, TN 37650
(423) 743-6141
(423) 743-1083
Mailing address
PO BOX 399, ERWIN, TN 37650
(423) 743-6141
(423) 743-1083
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RN0000049950
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3380594
—
TN
Enumeration date
05/18/2006
Last updated
11/25/2009
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