Provider Demographics
NPI:1730223975
Name:UNDERWOOD, WINNETTA (LVN)
Entity type:Individual
Prefix:
First Name:WINNETTA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:WINNETTA
Other - Middle Name:
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:937 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-1311
Mailing Address - Country:US
Mailing Address - Phone:510-444-3403
Mailing Address - Fax:
Practice Address - Street 1:2620 26TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1907
Practice Address - Country:US
Practice Address - Phone:510-437-2363
Practice Address - Fax:510-437-2366
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN46162164X00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse
Not Answered174400000XOther Service ProvidersSpecialist