MEDICARE: KATHARINE MACKNIGHT WINGERT CBD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		CA

General Provider Information

NPI Number	:	1356157614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE MACKNIGHT WINGERT CBD

Provider Business Mailing Address
First Line	:	24722 5TH ST
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-6226
Country	:	US
Telephone Number	:	714-296-2560
Fax Number	:

Provider Business Practice Location Address
First Line	:	24722 5TH ST
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-6226
Country	:	US
Telephone Number	:	951-249-3710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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