Provider Demographics
NPI:1023042926
Name:FERNANDO, WINEETHA (MD)
Entity Type:Individual
Prefix:
First Name:WINEETHA
Middle Name:
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 KS HWY 264
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-5353
Mailing Address - Country:US
Mailing Address - Phone:620-804-1022
Mailing Address - Fax:620-285-4579
Practice Address - Street 1:1301 KS HWY 264
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-5353
Practice Address - Country:US
Practice Address - Phone:620-804-1022
Practice Address - Fax:620-285-4579
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416062208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E36729Medicare UPIN
KS011510Medicare ID - Type Unspecified