Provider Demographics
NPI:1003691957
Name:DEQUARDO, WANDA JEANETTE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:JEANETTE
Last Name:DEQUARDO
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28176 COULTER
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4064
Mailing Address - Country:US
Mailing Address - Phone:949-201-8307
Mailing Address - Fax:
Practice Address - Street 1:17822 BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7172
Practice Address - Country:US
Practice Address - Phone:714-375-1122
Practice Address - Fax:949-863-8581
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95129597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner