Provider Demographics
NPI:1750140356
Name:NIEVES-WONG, BRENDA E (CD DONA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:NIEVES-WONG
Suffix:
Gender:F
Credentials:CD DONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 LUND AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3029
Mailing Address - Country:US
Mailing Address - Phone:407-452-2579
Mailing Address - Fax:
Practice Address - Street 1:1462 LUND AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3029
Practice Address - Country:US
Practice Address - Phone:407-452-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula