Individual
MRS. WANDA IVELISSE FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
CALLE CANADES 1324 AVE DE DIEGO, PUERTO NUEVO, PR 00920
(787) 763-7575
Mailing address
PO BOX 607087, BAYAMON, PR 00960-7087
(787) 763-7575
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
75212
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4436387
—
PR
Enumeration date
02/24/2023
Last updated
02/24/2023
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