| Doctor Name: | WANDA J PONCIK |
| NPI Number: | 1306948658 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 508505 |
| Business Practice Address: | 2625 Mcnutt Rd. Sunland Park, NM - 880639019 |
| Business Phone Number: | 5755890887 |
| Business Fax Number: | 5755890898 |
| Mailing Address: | 365 Calle De Alegra, Bldg. A LAS CRUCES |
| State: | NM |
| Postal Code: | 880053417 |
| Phone Number: | 5755261105 |
| Fax Number: | 5755244266 |
| NPI Enumeration Date: | 09/05/2006 |
| NPI Last Update Date: | 10/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 508505 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |