Provider Demographics
NPI:1528047685
Name:RODRIGUEZ, WANDA IVELISSE (RN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:IVELISSE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827 BOX 326
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U. S. NAVAL HOSPITAL NAPLES
Practice Address - Street 2:VIA CONTRADA BOSCARIELLO
Practice Address - City:GRICIGNANO
Practice Address - State:DI AVERSA CE
Practice Address - Zip Code:81030
Practice Address - Country:IT
Practice Address - Phone:01139081-811-6445
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013573163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator