Individual
ANDREA WYMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 773-8161
Mailing address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 749-9321
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
431191
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431191
NP LICENSE
NY
Enumeration date
10/22/2017
Last updated
04/08/2020
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