Provider Demographics
NPI:1235599978
Name:ROSENLUND, WANDA J
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:J
Last Name:ROSENLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 ALLARIZ CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6446
Mailing Address - Country:US
Mailing Address - Phone:775-425-4585
Mailing Address - Fax:775-425-4585
Practice Address - Street 1:2968 ALLARIZ CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6446
Practice Address - Country:US
Practice Address - Phone:775-425-4585
Practice Address - Fax:775-425-4585
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2023-03-13
Deactivation Date:2016-03-28
Deactivation Code:
Reactivation Date:2023-03-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child