Individual
MICHELLE L WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1790
(505) 722-1310
Mailing address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1790
(505) 722-1310
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.375643
IL
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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