Individual
INDIA NICOLE WOLFENDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
605 S COOLIDGE ST, MOSES LAKE, WA 98837-1873
(509) 765-0674
(509) 765-6591
Mailing address
605 S COOLIDGE ST, MOSES LAKE, WA 98837-1873
(509) 765-0674
(509) 764-0193
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60958714
WA
Other
Enumeration date
06/07/2019
Last updated
01/11/2021
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