Individual
ANDREW WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 S PINE ST, VIVIAN, LA 71082-3353
(318) 375-3239
Mailing address
PO BOX 792, VIVIAN, LA 71082-0792
(318) 375-3232
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
341036
LA
Other
Enumeration date
06/11/2021
Last updated
08/02/2024
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