Individual
WENONAH GWYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 PUMPHREY DR, FORESTVILLE, MD 20747-4308
(301) 735-5741
Mailing address
3333 PUMPHREY DR, FORESTVILLE, MD 20747-4308
(301) 735-5741
(301) 877-1181
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
16AL1226-A
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16AL1226-A
OHCQ
MD
01
—
16AL1226-A
OHCQ
—
Enumeration date
10/31/2019
Last updated
10/31/2019
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