Provider Demographics
NPI:1518648310
Name:WYNDER, IESHA (RN)
Entity Type:Individual
Prefix:
First Name:IESHA
Middle Name:
Last Name:WYNDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9091
Mailing Address - Country:US
Mailing Address - Phone:608-741-4500
Mailing Address - Fax:608-741-4502
Practice Address - Street 1:203 W SUNNY LN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9091
Practice Address - Country:US
Practice Address - Phone:608-741-4500
Practice Address - Fax:608-741-4502
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243081-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse