Individual
KRISTIN MARIE WYMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 237-9231
(574) 204-6355
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9231
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
28193580A
IN
363LF0000X
Family Nurse Practitioner
Primary
71008462A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169380084
MEDICARE PTAN
IN
01
—
247000032
MEDICARE PTAN
IN
01
—
261970104
MEDICARE PTAN
IN
05
—
300020098
—
IN
Enumeration date
09/25/2018
Last updated
04/29/2024
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