Individual
BEVERLY WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 792-9808
Mailing address
4120 BRIGADE TRL NW, KENNESAW, GA 30152-7722
(770) 424-6172
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
RN079004
GA
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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