Provider Demographics
NPI:1285490813
Name:YOUNG, WENDELINE JOYCE CORDERO (FNP)
Entity type:Individual
Prefix:
First Name:WENDELINE JOYCE
Middle Name:CORDERO
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-6807
Mailing Address - Country:US
Mailing Address - Phone:626-475-5366
Mailing Address - Fax:
Practice Address - Street 1:2707 E VALLEY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3196
Practice Address - Country:US
Practice Address - Phone:626-581-1000
Practice Address - Fax:626-581-1007
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95026916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner