Individual
SANDRA M. WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
122 12TH ST, PRINCETON, WV 24740
(304) 487-7000
Mailing address
PO BOX 634715, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
52866
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810003716
BLUE CROSS
WV
05
—
3810003716
—
WV
01
—
P00289697
MEDICARE RAILROAD
WV
Enumeration date
06/13/2006
Last updated
11/09/2007
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