Individual
WANDA C GONSALVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
740 S LIMESTONE K302, LEXINGTON, KY 40536-0001
(859) 323-4668
Mailing address
740 S LIMESTONE K302, LEXINGTON, KY 40536-0001
(859) 323-4668
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24000
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T80739
—
SC
Enumeration date
08/29/2006
Last updated
02/05/2014
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