Provider Demographics
NPI:1467874347
Name:WENMAN, WANDA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:MARY
Last Name:WENMAN
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 1:1325 BROWN DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0801
Mailing Address - Country:US
Mailing Address - Phone:530-759-9808
Mailing Address - Fax:
Practice Address - Street 1:1325 BROWN DR
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0801
Practice Address - Country:US
Practice Address - Phone:530-759-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 43250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics