Provider Demographics
NPI:1962294033
Name:OSINCUP, WENDY MARIE (CHW,CLC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:OSINCUP
Suffix:
Gender:F
Credentials:CHW,CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 NE KENNETH FORD DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1034
Mailing Address - Country:US
Mailing Address - Phone:541-440-3516
Mailing Address - Fax:541-440-3516
Practice Address - Street 1:280 NE KENNETH FORD DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1034
Practice Address - Country:US
Practice Address - Phone:541-440-3516
Practice Address - Fax:541-440-3516
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker