Healthcare Provider Details

I. General information

NPI: 1992326425
Provider Name (Legal Business Name): CAROL ANNETTE WINGFIELD APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DOCTOR CARREON BLVD STE D
INDIO CA
92201-5594
US

IV. Provider business mailing address

2328 SATELLITE BEACH DR
LAS VEGAS NV
89134-0404
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-7676
  • Fax:
Mailing address:
  • Phone: 202-361-1922
  • Fax: 702-973-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number835853
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: