Wanda Ivette Jimenez

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN9175240 Issued in FL

Practice address

338 S Dakota Ave
Vandenberg AFB, CA 93437-6307

Phone

(805) 606-1721

NPI assigned

Jul 11, 2024

Last updated

Jul 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1720656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1972340438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 S DAKOTA AVE",
            "city": "VANDENBERG AFB",
            "state": "CA",
            "postal_code": "934376307",
            "telephone_number": "805-606-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 S DAKOTA AVE",
            "city": "VANDENBERG AFB",
            "state": "CA",
            "postal_code": "934376307",
            "telephone_number": "805-606-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "WANDA",
        "middle_name": "IVETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "FL",
            "license": "RN9175240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer H Harris, PSY.D.
• Health and Wellness Center
• Daniel Anthony Jacobson
• William Francis Jennings, DMD
• Craig Jensen, O.D.
• Aaron A. Johnston, M.D.
• Melissa E Jordan
• Roxanne Keeney, RN
• David Bruce Kieser, D.D.S.
• Arthur Dwayne Kisby, PHARMD

• Administrator Registered Nurse in Vandenberg AFB, CA
• Providers in Vandenberg AFB, CA by specialty
• Administrator Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.