Provider Demographics
NPI:1568120251
Name:DECENT, WENDA ELIZABETH (RN)
Entity Type:Individual
Prefix:MISS
First Name:WENDA
Middle Name:ELIZABETH
Last Name:DECENT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:WENDA
Other - Middle Name:ELIZABETH
Other - Last Name:DECENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 E CYPRESS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1163
Mailing Address - Country:US
Mailing Address - Phone:530-223-2332
Mailing Address - Fax:530-223-4721
Practice Address - Street 1:1090 E CYPRESS AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1163
Practice Address - Country:US
Practice Address - Phone:530-223-2332
Practice Address - Fax:530-223-4721
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627320163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA823540239Medicaid