Provider Demographics
NPI:1568096592
Name:OUEDRAOGO, WENDABO AMINATA (NP)
Entity Type:Individual
Prefix:
First Name:WENDABO
Middle Name:AMINATA
Last Name:OUEDRAOGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 WEXHALL TER
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1908
Mailing Address - Country:US
Mailing Address - Phone:240-305-8751
Mailing Address - Fax:
Practice Address - Street 1:1232 RACE RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2351
Practice Address - Country:US
Practice Address - Phone:240-305-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD187611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily