| Doctor Name: | WONDA FAY ELMORE |
| NPI Number: | 1053546556 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 71002916B |
| Business Practice Address: | 1201 Michigan Ave Ste 140 Logansport, IN - 469471530 |
| Business Phone Number: | 5747531462 |
| Business Fax Number: | 5747531465 |
| Mailing Address: | 1201 Michigan Ave, Ste 140 LOGANSPORT |
| State: | IN |
| Postal Code: | 469471530 |
| Phone Number: | 5747531462 |
| Fax Number: | 5747531465 |
| NPI Enumeration Date: | 05/27/2009 |
| NPI Last Update Date: | 12/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71002916B |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |