Basic Information
| Provider Information | |||||||||
| NPI: | 1992768071 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WENDOVER OB-GYN & INFERTILITY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362744590 | ||||||||
| FaxNumber: | 3362731948 | ||||||||
| Practice Location | |||||||||
| Address1: | 1908 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362732835 | ||||||||
| FaxNumber: | 3362731948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | INSURANCE & BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3362732835 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.