Provider Demographics
NPI:1205670932
Name:MWENDE, WINFRED
Entity type:Individual
Prefix:
First Name:WINFRED
Middle Name:
Last Name:MWENDE
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 1:13264 RAMONA BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3882
Mailing Address - Country:US
Mailing Address - Phone:773-633-3907
Mailing Address - Fax:
Practice Address - Street 1:13264 RAMONA BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3882
Practice Address - Country:US
Practice Address - Phone:773-633-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95321191163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics