Provider Demographics
NPI:1366102519
Name:WYNN-ATKINS, GOLANDA JEANNETTE
Entity type:Individual
Prefix:
First Name:GOLANDA
Middle Name:JEANNETTE
Last Name:WYNN-ATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 LAKELAND ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-2123
Mailing Address - Country:US
Mailing Address - Phone:318-313-9327
Mailing Address - Fax:
Practice Address - Street 1:3502 LAKELAND ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-2123
Practice Address - Country:US
Practice Address - Phone:318-313-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker