Individual
MRS. TRACY ANN MOONEY WYNDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
207 EVERHART ST, DUPONT, PA 18641-2107
(570) 262-8534
Mailing address
207 EVERHART ST, DUPONT, PA 18641-2107
(570) 262-8534
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN526993L
PA
163WH0200X
Home Health Registered Nurse
Primary
RN526993L
PA
163WW0000X
Wound Care Registered Nurse
RN526993L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN526993L
RN
PA
05
—
RN526993L
—
PA
Enumeration date
09/08/2010
Last updated
09/08/2010
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