Provider Demographics
NPI:1003497223
Name:MACEDO, WENDY (NP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MACEDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LOCKHEED WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93599-0001
Mailing Address - Country:US
Mailing Address - Phone:661-572-2974
Mailing Address - Fax:
Practice Address - Street 1:1011 LOCKHEED WAY
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93599-3240
Practice Address - Country:US
Practice Address - Phone:661-572-2190
Practice Address - Fax:661-572-2150
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily