Wenonah Gwynn
Individual provider Active NPI Assisted Living Facility · Forestville, MD
NPI 1073157293 · NPPES record last updated Oct 31, 2019
Key facts
- NPI
- 1073157293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 16AL1226-A (MD)
- Practice address
- 3333 Pumphrey Dr
Forestville, MD 20747-4308 - Phone
- (301) 735-5741
- NPI assigned
- Oct 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16AL1226-A | MD | MD | Assisted Living Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 16AL1226-A | MD | Yes |
Addresses
Primary practice location
3333 Pumphrey Dr
Forestville, MD 20747-4308
Mailing address
3333 Pumphrey Dr
Forestville, MD 20747-4308
Phone (301) 735-5741
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16AL1226-A | Other | OHCQ | |
| 16AL1226-A | Other | MD | OHCQ |
Other providers in Forestville, MD
- Courtney Grace Goode
- Goodman Eyecare Center, LLC
- Bruce Goodman
- Dajuana Goodman
- Nicole Griffith
- Harden Pmhnp Practice LLC
- Arithia Harden
- Michelle Hare
- Buzz Matthew Harley
- Donishia S Harris
All providers in Forestville, MD · Assisted Living Facility in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.