Provider Demographics
NPI:1902789944
Name:STEPHENS, WANDA S
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:S
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672-1837
Mailing Address - Country:US
Mailing Address - Phone:330-581-2110
Mailing Address - Fax:
Practice Address - Street 1:645 W TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672-1837
Practice Address - Country:US
Practice Address - Phone:330-581-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion