Provider Demographics
NPI:1982752895
Name:WIELENGA, JUANITA (CNM)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:WIELENGA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4000 14TH ST
Mailing Address - Street 2:SUITE #314
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4083
Mailing Address - Country:US
Mailing Address - Phone:951-781-7140
Mailing Address - Fax:951-781-7184
Practice Address - Street 1:4000 14TH ST
Practice Address - Street 2:SUITE #314
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4083
Practice Address - Country:US
Practice Address - Phone:951-781-7140
Practice Address - Fax:951-781-7184
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANMW1014367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife