Provider Demographics
NPI:1588375661
Name:WYNDHAM, DAVID TIMOTHY
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:TIMOTHY
Last Name:WYNDHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1182
Mailing Address - Street 2:
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463-1182
Mailing Address - Country:US
Mailing Address - Phone:541-844-8376
Mailing Address - Fax:
Practice Address - Street 1:48228 HIGHWAY 58 UNIT 32
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9620
Practice Address - Country:US
Practice Address - Phone:541-844-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide