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Individual

KATRENIA J WYCOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, A/GNP-C

Contact information

Practice address
9900 BREN ROAD EAST, MINNETONKA, MN 55343-9664
(903) 681-8334
Mailing address
9900 BREN RD E, MINNETONKA, MN 55343-9664

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
251261
TX
363LG0600X
Gerontology Nurse Practitioner
251261
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
29335903
TX
Enumeration date
05/12/2006
Last updated
09/17/2020
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