Individual
CHANTEL WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
511 E COLUMBUS AVE, SPRINGFIELD, MA 01105-2506
(413) 923-6747
Mailing address
65 MELVILLE ST, SPRINGFIELD, MA 01104-2730
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN102166
MA
Other
Enumeration date
05/03/2024
Last updated
05/03/2024
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