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NPI Code Detail

MEDICARE: NATALIE RAE WYNN APRN

MEDICARE: NATALIE RAE WYNN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0000XPain Management Registered NurseRN46729NV
2363L00000XNurse Practitioner815950NV

General Provider Information

NPI Number : 1407487077
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATALIE RAE WYNN APRN
Provider Business Mailing Address
First Line : 6120 S FORT APACHE RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-6760
Country : US
Telephone Number : 702-948-8660
Fax Number :
Provider Business Practice Location Address
First Line : 6120 S FORT APACHE RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-6760
Country : US
Telephone Number : 702-848-4443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2020
Last Update Date : 08/05/2024

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Directions to “ NATALIE RAE WYNN APRN” Practice Location

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