Individual
MICHELLE KATHLEEN WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3937 PINES RD, SUITE H, SHREVEPORT, LA 71119-7301
(318) 635-1668
Mailing address
3937 PINES RD, SUITE H, SHREVEPORT, LA 71119-7301
(318) 635-1668
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
09989
LA
Other
Enumeration date
05/22/2012
Last updated
05/22/2012
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