Provider Demographics
NPI:1265075428
Name:WENDEMINEH, MARTHA TSEGA (BSN, FNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:TSEGA
Last Name:WENDEMINEH
Suffix:
Gender:F
Credentials:BSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N CEDAR ST APT 29
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-8095
Mailing Address - Country:US
Mailing Address - Phone:559-483-6682
Mailing Address - Fax:
Practice Address - Street 1:930 N CEDAR ST APT 29
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-8095
Practice Address - Country:US
Practice Address - Phone:559-483-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF10190803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily