Provider Demographics
NPI:1992326425
Name:WINGFIELD, CAROL ANNETTE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNETTE
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 SATELLITE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0404
Mailing Address - Country:US
Mailing Address - Phone:202-361-1922
Mailing Address - Fax:702-973-0173
Practice Address - Street 1:81812 DOCTOR CARREON BLVD STE D
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5594
Practice Address - Country:US
Practice Address - Phone:760-347-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835853363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health