Individual
LANETA T WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2501 W BURBANK BLVD, BURBANK, CA 91505-2347
(877) 929-6863
Mailing address
4715 7TH AVE, LOS ANGELES, CA 90043-1339
(323) 397-9383
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
95030436
CA
Other
Enumeration date
12/23/2024
Last updated
09/10/2025
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