Individual
ERICA LARAE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14139 POTOMAC MILLS RD, WOODBRIDGE, VA 22192-4644
(703) 490-7740
Mailing address
14139 POTOMAC MILLS RD, WOODBRIDGE, VA 22192-4644
(703) 490-7740
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101236466
VA
208000000X
Pediatrics Physician
MD035456
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5-021-162-2
USMLE
—
Enumeration date
11/16/2006
Last updated
01/08/2008
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