Provider Demographics
NPI:1760485783
Name:MCBRIDE, VINNOLIA (WHCNP)
Entity Type:Individual
Prefix:
First Name:VINNOLIA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:VINNOLIA
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHCNP
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:520-836-8807
Practice Address - Street 1:1864 E FLORENCE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5504
Practice Address - Country:US
Practice Address - Phone:520-381-0380
Practice Address - Fax:520-836-1826
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7091363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ381228Medicaid
AZZ195133Medicare Oscar/Certification
AZZ165308OtherMEDICARE
ZFQ31815OtherMEDICARE
AZ031916OtherMEDICARE
03-1881OtherMEDICARE