Provider Demographics
NPI:1730835174
Name:OUEDRAOGO, WINDYAM K
Entity type:Individual
Prefix:
First Name:WINDYAM
Middle Name:K
Last Name:OUEDRAOGO
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 1:4530 WARRENSVILLE CENTER RD APT 310F
Mailing Address - Street 2:
Mailing Address - City:NORTH RANDALL
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4173
Mailing Address - Country:US
Mailing Address - Phone:216-632-3456
Mailing Address - Fax:
Practice Address - Street 1:4530 WARRENSVILLE CENTER RD APT 310F
Practice Address - Street 2:
Practice Address - City:NORTH RANDALL
Practice Address - State:OH
Practice Address - Zip Code:44128-4173
Practice Address - Country:US
Practice Address - Phone:216-632-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health