Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 3004584 | KY |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 3004584 | KY |
NPI | 1023061728 |
---|---|
Provider Name | Mrs. Nancy C Wynn |
First Address | Louisville, KY 40216-1727 |
Second Address | Louisville, KY 40216-1727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000537179 | ANTHEM (01) | |
710034392 | (05) | KY |
P70978 | (02) | KY |