Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | MD073532L | PA |
NPI | 1902233992 |
---|---|
Provider Name | Juliet E Wynn |
First Address | Bridgeville, PA 15017-1833 |
Second Address | Bridgeville, PA 15017-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2013 |
Last Update Date | 04/10/2013 |