1750509683 NPI number — MRS. CARRISSA VERONIQUE WYNDER-NANDLAL DNP, MS, RN, CCM

Table of content: (NPI 1700583754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750509683 NPI number — MRS. CARRISSA VERONIQUE WYNDER-NANDLAL DNP, MS, RN, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYNDER-NANDLAL
Provider First Name:
CARRISSA
Provider Middle Name:
VERONIQUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, MS, RN, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANCHEZ
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
CAPTAIN
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750509683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 N CEDAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENKINTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-817-6210
Provider Business Mailing Address Fax Number:
800-681-7881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE 904
Provider Business Practice Location Address City Name:
Philadelphia
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-861-4514
Provider Business Practice Location Address Fax Number:
443-380-5718
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WA2000X , with the licence number:  RN598454 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WC0400X , with the licence number: 00041902 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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