Provider Demographics
NPI:1952602872
Name:WACONDO, CATHERINE WHELIMINA (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:WHELIMINA
Last Name:WACONDO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:WHELIMINA
Other - Last Name:WACONDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:PO BOX 1232
Mailing Address - Street 2:PHS ON36A
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1232
Mailing Address - Country:US
Mailing Address - Phone:605-867-1633
Mailing Address - Fax:
Practice Address - Street 1:US HWY 18 PINERIDGE IHS
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1232
Practice Address - Country:US
Practice Address - Phone:605-867-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse