Healthcare Provider Details

I. General information

NPI: 1902194939
Provider Name (Legal Business Name): JOANNA LYNN GENDREAU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA LYNN WIGFIELD

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 TURNING STONE TRL
KALAMAZOO MI
49009-8448
US

IV. Provider business mailing address

8132 TURNING STONE TRL
KALAMAZOO MI
49009-8448
US

V. Phone/Fax

Practice location:
  • Phone: 330-605-4004
  • Fax: 330-970-7090
Mailing address:
  • Phone: 330-605-4004
  • Fax: 330-970-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number312665
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number006276
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number006276
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: