Individual
IVANA WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
385 S MANCHESTER AVE UNIT 1110, ORANGE, CA 92868
(562) 743-2451
Mailing address
385 S MANCHESTER AVE UNIT 1110, ORANGE, CA 92868-3243
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95006800
CA
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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