Provider Demographics
NPI:1609000868
Name:FLOYD, WANDA (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:14598 GENERAL WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3253
Mailing Address - Country:US
Mailing Address - Phone:571-237-6953
Mailing Address - Fax:703-783-8543
Practice Address - Street 1:14598 GENERAL WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3253
Practice Address - Country:US
Practice Address - Phone:571-237-6953
Practice Address - Fax:703-783-8543
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001099814171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor