Wenonah Gwynn

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

16AL1226-A Issued in MD

Practice address

3333 Pumphrey Dr
Forestville, MD 20747-4308

Phone

(301) 735-5741

NPI assigned

Oct 31, 2019

Last updated

Oct 31, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1073157293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 PUMPHREY DR",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207474308",
            "telephone_number": "301-735-5741",
            "fax_number": "301-877-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 PUMPHREY DR",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207474308",
            "telephone_number": "301-735-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWYNN",
        "first_name": "WENONAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "16AL1226-A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHCQ",
            "identifier": "16AL1226-A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHCQ",
            "identifier": "16AL1226-A",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Grace Goode, OD
• Goodman Eyecare Center, LLC (My Eye Dr.)
• Bruce Goodman, OD
• Dajuana Goodman
• Nicole Griffith
• Harden Pmhnp Practice LLC
• Arithia Harden, PMHNP
• Michelle Hare
• Buzz Matthew Harley
• Donishia S Harris

• Assisted Living Facility in Forestville, MD
• Providers in Forestville, MD by specialty
• Assisted Living Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.