Individual
TANYA WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
541 MOONACHIE RD, SOUTH HACKENSACK, NJ 07606-1640
(201) 212-8278
Mailing address
541 MOONACHIE RD, SOUTH HACKENSACK, NJ 07606-1640
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
275824
NY
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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