Provider Demographics
NPI:1629337787
Name:WENJA, VANESSA PALVINE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:PALVINE
Last Name:WENJA
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 1:6304 MARTINS LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1122
Mailing Address - Country:US
Mailing Address - Phone:240-550-8914
Mailing Address - Fax:
Practice Address - Street 1:6304 MARTINS LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1122
Practice Address - Country:US
Practice Address - Phone:240-550-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW520839676174374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide