Individual
CHARLOTTE CASEY WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(334) 272-9684
Mailing address
1735 KESTWICK CIR, HOOVER, AL 35226-2347
(334) 782-2642
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-040730
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000029766
—
AL
01
—
051029766
BLUE CROSS
AL
Enumeration date
04/24/2006
Last updated
09/09/2020
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